
e 



Class _Jv^LlI 



Book_ 
Copyright )^°_ 



;Afi 



COPYRIGHT DEPOSIT. 



CATECHISM 



OF THE 



Principles of Veterinary 
Surgery 



BY 



W. E. A. WYMAN, M.D.V., V.S. 

AtTTHOB, OP "The Clinical Dlignosis of Lameness in the Horse," 

" Tibio-Peroneal Neurectomy," Translator op 

De Bruin's "Bovine Obstetrics," etc. 




New York 
WILLIAM R. JENKINS 

VETERINARY PUBLISHER AND BOOKSELLER 

851 AND 853 Sixth Avenue 

1905 



LIBRARY of JONGKtsS 
Two Copies rtucnvou 

JUL 8 lyUi) 

Coi^it;iii tniry 
SS 'CL XXc. Not 




4"- 



Copyright, 1905, by Wiluam R. Jenkins 



J.ZZ rights reserved 



printed by the 
Press of "William R. Jenkins 



PREFACE. 



Nobody can diagnose, treat and prognose a surgical case 
intelligently unless thoroughly acquainted with the scientific 
principles involved in any particular case. The student is 
obliged to gain his knowledge of the various surgical 
*' ologies " by lectures, and after all by the perusal and study 
of works written for the human practitioner. The former is 
insufficient and the latter obviously wrong. 

The principles applicable to human surgery and those of 
veterinary surgery, while in a great many instances closely 
related, nevertheless differ materially. For instance, asepsis, 
a condition sine qua non to the human surgeon, as a rule 
exists in veterinary surgery only in theory, although lately 
some of the leading surgeons in human surgery lean strongly 
toward antisepsis. In human surgery, periostitis plays an 
unimportant role, while it is of vital importance to the equine 
practitioner. Notice the difference in the prognosis and 
treatment of fractures. How many human surgeons apply 
the firing iron and blisters ? This work is purely for the 
veterinarian. As a former teacher of veterinary students, I 
am fairly conversant with their needs. It has been my most 
earnest desire and effort to supply a work which, while 
scientific and modern, is free from matters of doubtful in- 
terest to the American student. 



IV PREFACE 

The student requires a work which explains ; it is for 
this reason that I wrote this work in questions and answers. 
Depending on the importance of the subject from a practical 
standpoint, a more or less exhaustive discussion has been 
indulged in, exemplified by every-day cases. 

Occasionally the therapeutic part of this work has become 
a little more extensive than probably permissible in a work 
on the Principles of Surgery. The only apology which I offer, 
if such is necessarj^, consists in the desire to supply the stu« 
dent with certain reliable facts which he cannot find in print 
elsewhere. 

In arranging and classifying the various subjects, I fol- 
lowed Prof. Dr. Eug. Frohner's masterly exhibition on 
General Surgery, which Prof. Frohner kindly permitted me 
to do and for which I herewith extend my best thanks. 

Illustrations are omitted, as the clinic, the histological, 
pathological and anatomical laboratories should supply the 
student with the real thing. 

W. E. A. Wyman. 



CONTENTS. 



PAGE 

General Surgery 1 

Arrest of Hemorrhage 7 

The Healing of Wounds 13 

Abnormal Granulations and Cicatrization 17 

Regeneration of the Various Tissues 19 

Traumatic Infectious Diseases 21 

Suppuration of Wounds 21 

Cellulitis 23 

Traumatic Fever 28 

Septicemia 29 

Pyemia 32 

Specific Traumatic Infectious Diseases 34 

Malignant CEdema 34 

Tetanus 35 

The Treatment op Wounds 39 

The Treatment op Specific Wounds 43 

Contusions 47 

Subcutaneous Ruptures 52 

Ruptures of Muscles 52 

Ruptures of Tendons 53 

Inflammation o 55 

Causes 56 

Varieties 57 

Symptoms 59 

Course and Termination 60 

Treatment 62 

Abscess 69 



Tl CONTENiS 

PAGE 

TJlcer ... 7a 

Fistula 7T 

Gangrene 81 

Tumors 86 

Connective Tissue Tumors 90 

Fatty Tumors 95 

Mucous Tumors 96 

Cartilaginous Tumors 98 

Osseous Tumors 99 

Muscular Tumors 99 

Nerve Tumors lOO 

Vascular Tumors 102 

Lymphatic Gland Tumors 103 

Sarcoma 104 

Carcinoma 108 

Papilloma 115 

Adenomata 117 

Cysts 118 

Actinomycoma 121 

Botryomycoma 125 

Tuberculosis 128 

Concretions and Foreign Bodies 132 

Hernia and Prolapsus „ 141 

Diseases op Bones 151 

Fractures o 151 

Inflammation 178 

Periostitis » . . . „ . o 179 

Osteomyelitis 184 

Necrosis 185 

Atrophy 189 

Hypertrophy 190 

Rachitis (Rickets) 191 

Osteomalacia 192 



CONTENTS Vii 

PAGE 

Diseases of Articulations 195 

Arthritis „ , 195 

Luxation „ „ 205 

Distortion 209 

Contusion .„ „ 213 

Anchylosis „ 213 

Contracture 215 

Loose Bodies in the Joint 217 

Diseases of Tendons ,,o 219 

Tendinitis 219 

Rupture , 225 

Necrosis 228 

Diseases of Synovial Sheaths of Tendons . . . » , 230 

Inflammation , 230 

Galls 233 

» 

Diseases of the Mucous Bursa 236 

Bursitis , , 236 

Dropsy „ 238 

Myositis o . . » , 239 

Rupture „. » « » o 246 

Atrophy o , 248 

Diseases of Aponeuroses , o , 51 

Diseases of Nerves , 254 

Diseases of Arteries , , = . . » « 263 

Arteritis , 263 

Aneurism 264 

Rupture , 268 

Diseases of Veins 270 

Phlebitis o 270 

Varix 273 

Diseases of Lymph Vessels 273 

Lymphangitis 373 

Lymphangiectasia 276 



Viii CONTENTS 

PAGE 

Diseases op Glands 276 

Lymphadenitis 276 

Mammitis — Mastitis 279 

Diseases of the Skin 286 

Dermatitis 286 

Burns and Scalds 293 

Diseases of Mucous Membranes 300 

Diseases of the Subcutis 301 

Edema 301 

Emphysema 303 

Congenital Malformations 305 



PEINCIPLES OF 

Veterinary Surqery. 



GENERAL SURGERY. 

Define a wound. 

A breach of continuity of tlie skin and mucous mem- 
"brane by sudden mechanical force. 

What two headings may wounds he classed under ? 

1. Open wounds, where the break in the surface is about 
equal in extent to the deeper injury. 

2. Subcutaneous wounds, where the break in the skin is 
either wanting or very limited as compared with the deeper 
lesions. 

Depending on the cause, what kinds of open wounds are 
recognized 9 
(1) Incised or clean cut ; (2) punctured or pierced ; (3) 
lacerated or torn ; (4) contused or bruised ; (5) gunshot or 
punctured-lacerated-contused. 

What qualitative classification of wounds may be made 9 

Simple and complicated, flap wounds, clean, dirty (dust, 
shavings), infected, poisoned, deep, perforating and super- 
ficial, fresh and bleeding, old granulating and suppurating 

wounds. 

1 



2 PRINCIPLES OF VETERINARY SURGERY 

According to the seat of tissues involved, what ivounds are 
recognized ? 
Abdominal, thoracic, cervical, etc.; muscular, bony, 
corneal, intestinal, skin wounds, etc. 

Name the most important general symptoms of a fresh wound ? 
Hemorrhage, retraction of the edges (gaping), pain, 
disturbed function, systemic disturbance. 

To what is the pain in afresh ivound due ? 

The so-called primary wound pain, which must be differ- 
entiated from the secondary wound ]3ain setting in later on 
and due to inflammatory changes, depends on the cutting 
and tearing of sensitive nerve fibres, and the richer the 
injured part is endowed with nerves the greater the pain. 

Are the luounds of all tissues equally painful ? 

Injury of the cranial contents, bones, cartilage, tendons 
and connective tissue are less painful than wounds of the 
cornea, periosteum, skin, mucous membrane (especially 
marked when the cutting agent is dull and its action 
delayed). 

To what extent do the various animals react to pain ? 

There is a great difference, depending on the age, sex, 
breed, species and temperament. Dogs are more sensitive 
than horses, and these more so than the ox. The individual 
disposition also plays an important role. Thus some horses 
can be fired without reacting perceptibly while others plunge 
about violently. 

What hind of hemorrhages are met with in wounds ? 

1. Arterial hemorrhage : the bright red blood appears 
in jets synchronously with the pulse beat. 



GENERAL SURGERY 3 

2. Venous hemorrhage : dark-red blood in a continuous 
stream flows from the vessel. 

3 . Parenchymatous hemorrhage : this is a mixed hemor- 
rhage, as arteries and veins of small calibre are cut, the 
blood drips from the wound about in the same manner as 
water would from a sponge, and is of dark-red color. 

4. Capillary hemorrhage : the blood drips in small drops 
from light wounds of the skin and mucous membrane, the 
capillary blood-vessels being cut. 

What else besides blood may floiv from wounds ? 

In case a large lymph vessel is cut, lymph; injury to 
articulations and tendon sheaths, synovia; injury of salivary 
glands, stenos duct and oesophagus, saliva; injury to 
stomach, /oofZ ; injury to intestines, /feces y injury of udder, 
Tnilh; injury of bladder and urethra, urine. 

What is understood by gaping of the wou7id f 

Tissues possessing more or less elasticity, the edges of 
a wound retract. The amount of gaping depends on the 
nature of the cut tissues and the direction of the wound ; 
thus wounds cutting across the fibres of muscles or tendons, 
or where the skin is especially tense, gape most. 

What is understood by disturbed function ? 

The part wounded suffers more or less loss of function. 
Wounds of the hoof, tendons, articulations, muscles, cause 
lameness ; those of the cornea disturb sight ; those of the 
tongue interfere with feeding. 

To what extent do ivounds influence the general health 9 

Very painful wounds depress the animal to such an 
extent that it refuses food, more noticeable in the horse and 



4 PRINCIPLES OF VETERINARY SURGERY 

dog. True shock as seen in man (vasomotor jiaresis, the 
blood accumulating in the abdominal vessels ; shallow res- 
piration ; weak, compressible pulse ; clamy, profusely per- 
spiring skin ; absence of mental originating power) is rarely 
met with in animals ; while following serious loss of blood 
pale mucous membranes, weak pulse, depression, etc. 
(anaemia), are observed. Occasionally sudden death follows 
the aspiration of air from an injured jugular vein, death 
being explained by air embolism of the pulmonary capil- 
laries, filling of the cavities of the heart with air or air 
embolism of the capillary vessels of the brain. 

What two forms of traumatic fever Tnay produce systemic 
disturbances ? 

1. Aseptic wound fever : here a slight rise of temperature 
without detectable systemic disturbance follows the absorp- 
tion of pyrogenous material from the wound. 

2. Septic fever. High temperature and decided systemic 
disturbance due to the entrance of some specific infectious 
material into the wound and later into the general cir- 
culation. 

Hoiv ivould you describe any wound 9 

(1) Region of the body (neck, thorax, leg, etc.) ; (2) 
length, width, depth, shape, direction ; (3) edges of the 
wound (sharp, lacerated, flap, swollen, inverted, etc.) ; (4) 
secretion : odor, quantity, consistency, color ; (5) by palpa- 
tion with finger or probe the presence of foreign bodies and 
depth are learned. Fresh and deep wounds of the articu- 
lations, abdominal, cranial and thoracic cavities, tendon 
sheaths, and those where deep and serious hemorrhage was 
arrested, should not be probed. 



GENERAL SURGERY 5 

Describe incised wounds. 

Cause — Sharp cutting instrument, as surgeon's knife^ 
glass, pieces of tin, sabre. 

Characteristics — Straight, oblong shape, gape widely, as a 
rule bleed freely, clean cut edge ; according to depth, they 
are tendinous, muscular, bony or skin wounds. 

Prognosis— Favorable in skin wounds, otherwise the 
question of economy, the amount and kind of tissue des- 
troyed, must be decisive. 

Describe punctured luounds. 

Causes — Pointed instruments, as dung forks, nails, 
needles, harrow teeth, splinters, bayonet, trocar, hypodermic 
needle. 

Characteristics — Small roundish opening, leading into a 
canal of more or less depth, with limited hemorrhage unless 
a larger vessel has been pierced ; they may be perforating 
and communicate with a joint, tendon sheath, abdominal or 
thoracic cavity, etc. 

Prognosis — Surgically clean instrument, even when caus- 
ing a perforating wound, entitles to a favorable prognosis, 
while the introduction of septic material, as by manure forks, 
nails, etc., may lead to fatal complications. Punctured 
wounds of the hoof may be followed by tetanus, while this. 
form of injury of the softer tissues may in turn produce- 
septic cellulitis, septicaemia, pysemia, etc. 

Describe lacerated wounds. 

Causes — Tearing of tissues by nails, hooks, caulks, etc. 

Characteristics — Slight hemorrhage, moderate gaping ; 
edges may be smooth or lacerated ; frequently a flap wound 
and then usually an angular tear. 



6 PRINCIPLES OP VETERINARY SURGERY 

Prognosis — Depends on tlie part involved and extent of 
the lesion. Since there is more or less tendency to necrosis, 
this fact must be borne in mind in making a prognosis. 

What part of the body is often involved 9 

In the horse, the eyelids, croup, breast and hind legs and 
false nostril ; in the dog, the cornea when fighting with cats. 

Describe contused ivounds. 

Causes — The action of a blunt instrument, as kicks, falls, 
running against unyielding objects, coronary caulks, lying 
for some time on hard and rough ground ; rope burns. 

Characteristics — When of a superficial nature the upper 
layers of the skin only are removed : abrasion, excoriation. 
Deep contused wounds exhibit little or no bleeding, as the 
separation of the intima and media from the adventitia of 
the bleeding vessel closes the lumen of the vessel on the same 
principle that the emasculator or ecraseur prevents bleeding. 
The edges are irregular, discolored, feel cold ; the neigh- 
borhood is swollen ; the wound contains partially detached 
tissue and bloodclots. 

Prognosis — There is always sloughing, and the prognosis 
is based to a great extent upon the possibility of securing 
perfect drainage and thus preventing septic infection. 

To what class of wounds do those created by the teeth of 
animals belong ? 

The bites of dogs and cats are more common than those 
of the horse or ox. Such wounds are either punctured, 
contused or lacerated, or a combination of the above. Dog 
bites quite often cause complicated fractures. 

Describe gunshot wounds. 

Cause — Projectiles, as buck and bird shot, pistol and 
rifle balls. 



ARREST OF HEMORRHAGE 7 

Characteristics — It is a contused, lacerated wound ; there 
is a wound of entrance and possibly a wound of exit. The 
wound of entrance is smaller than the ball, because the skin 
is stretched as the ball hits it ; should it be larger than the 
ball, a foreign body has been carried in with it. With the 
shot fired close to the animal, the hair is singed by the 
powder ; when . the ball grazes the surface a friction burn 
results. The wound of entrance has either smooth, frizzled 
or lacerated and depressed edges. Hemorrhage is wanting 
unless a larger vessel has been cut. The wound of exit is 
larger than the ball, irregular and everted. 

Prognosis — Unless septic material has been carried in by 
the missile, the probe or the surgeon's finger, or vital parts 
destroyed or injured so as to interfere with the future use- 
fulness of the animal, the prognosis is good. 

Which animals are most exposed to gunshot wounds 9 

In times of war, the horse ; during hunting seasons, all 
domestic animals get their share ; otherwise, hunting-dogs 
and cats. 

Define poisoned wounds. 

Wounds in which a poison has been introduced, as by 
snake-bite, bee or wasp sting, or which have been infected by 
glanders, rabies, anthrax, tetanus. 



ARREST OF HEMORRHAGE. 

Hoiv is bleeding stoj)ped 9 

(1) Spontaneously ; (2) artificially. 
How does spontaneous arrest of hemorrhage take place ? 

It is mostly seen in capillary, parenchymatous hemor- 
rhage and when small veins are cut ; a clot (thrombus) 



8 TRINCIPLES OP YETERINAEY SURGERY 

forms, also retraction and contraction of the cut end of 
the vessel. When a large blood-vessel is cut, spontaneous 
arrest of hemorrhage is due to retraction and contraction 
and thrombus formation at the cut end plus enfeebled heart 
action and changed composition of the blood. 

Why does spontaneous arrest of hemorrhage in small vessels 
readily occur ? 
Because blood pressure is very limited in capillaries 
and small veins, thus favoring the formation of a clot 
(thrombus). 

Hoiu does the changed composition of the hlood following 
serious bleeding encourage clot formation ? 
The changed composition of the blood mainly consists in 
a decided increase of tho white blood cells, by which its 
coagulability is greatly increased. 

Hoiu much hlood may an animal lose before succumbing to 
fatal cardiac or cerebral syncope ? 
Not over one-third of the total amount of blood, 

Hoiu quickly does the blood regenerate after a hemorrhage f 
The quantity of the blood is quite speedily replaced by 
resorption of the lymph of the tissues and the liquids of the 
stomach and intestines ; the quality of the blood is at first 
very watery, regeneration of the red blood cells being a slow 
process. 

How is a thrombus formed ? 

There are two kinds, the white and the red thrombus. 
The former is met with in the healthy tinimal, the latter is 
seen in septic states. At the same time both may exist 
together, and the thrombus is then termed a mixed thrombus. 



■ ARRE^^T OF HExMORUHAGE 9 

The white thrombus is formed by the white blood cells and 
Bizzozero's blood plaques, and is, so to speak, a physiological 
product and not a coagulum. The red thrombus is a patho- 
logical product, consisting of a fibrin constituted coagulum 
plus red blood cells met with in the vessels of animals 
suffering with septic disease. 

What becomes of the white thrombus ? 

When aseptic, it organizes ; when infected, it softens and 
breaks up into emboli. 

What is understood by organization of a thromhus 9 

Its replacement by connective tissue. The new con- 
nective tissue formed results from proliferation of the endo- 
thelial cells of the vessel ; the thrombus itself only j)lays 
a passive role. The endothelial cells of the intima of the 
vessel take on a spindle shaped and multiform character, 
advance, perforate and surround the thrombus, developing 
later into fibrillar connective tissue cells, thus replacing the- 
thrombus by connective tissue ; while this occurs new blood 
vessels are formed from the vasa vasorum. This is termed 
the vascularization of the thrombus. 

How much time is consurtied in the process of organization 
and vascularization ? 
About four weeks. 

What else may become of a thrombus ? 

It may calcify and form a phlebolit (vein stone). 

How is tlie circidation interrupted by the thrombus re- 
established ? 
A collateral circulation forms. The vasa vasorum be- 
come larger and the central and peripheral arterial branches 
of the thrombus meet. 



10 PRINCIPLES OF VETERINARY SURGERY 

What is understood hy softening of the thrombus ? 

When bacteria invade a thrombus it becomes infected 
and breaks up into little particles (emboli), which on entering 
the general circulation cause a general infection of the 
body (pysemia). 
Define artificial arrest of hemorrhage. 

The application of means which encourage coagulation 
or close the bleeding vessel. 

Hoiu do you chech hemorrhage 9 

(!) By ligation; (2) compression; (3) torsion; (4) cautery; 
(5) heat; (6) cold; (7) remedial agents; (8) constitutional 
treatment. 

Hoiv is hemorrhage arrested hy ligation 9 

It is the only safe means when large arteries or veins 
are cut. If possible, grasp the bleeding vessel with the 
artery forceps, draw it out of the Avound, isolate it froin 
the surrounding tissue, and with a surgical knot tie both 
extremities of the vessel. When tying this knot, do not tie 
the second one too tight, as it loosens the first one. If the 
bleeding vessel cannot be caught, it may be necessary to 
cut down onto it, or the less desirable method of carrying 
a curved needle underneath the vessel and tying it and all the 
tissues enclosed by the ligature. Avoid tying in a nerve. 
At times for anatomical reasons the bleeding vessel ought 
not to be ligated at its cut end, but ligation in continuity 
is indicated, as, for instance, injury of the internal carotid 
requires ligation of the carotid artery, or injury to the inter- 
osseous artery demand.^ tying of the radial artery. 

What material is used to ligate bleeding vessels f 
Aseptic silk or catgut. 



ARREST OF HEMORRHAGE 11 

JIoio do you clieck hemorrhage by compression 9 

It is employed in capillary and parendiymatous bleeding 
and when small vessels are cut. An exception to this rule is 
made in very dangerous hemorrhages, when the course of the 
vessel is either compressed with the finger (digital compres- 
sion), or anything which is readily accessible is temporarily 
crowded into the wound to compress the vessel. In these 
cases, when possible, a string or rope, cloth, etc., is tightly 
wound around the parts to constrict the whole member until 
other means can be employed, as far as possible observing 
antisepsis. 

What material is used to compress the bleeding parts 9 
Sterilized oakum, absorbent cotton, bandages. 

What is torsion and how does it act as a hemostatic 9 

It consists in seizing the vessel with an artery forceps 
and twisting it six to eight times ; as a rule, it is used only 
in smaller vessels. By twisting the vessel around its own 
axis the intima and media become detached and curl up, 
while the adventitia becomes twisted; the lumen of the vessel 
thus becoming smaller or closed. 

How does the actual cautery act as a hemostatic 9 

In smaller vessels the mere radiation of the dull-red 
cautery causes coagulation, while an eschar is formed when 
the cautery touches the bleeding end. It is mainly employed 
in parenchymatous bleeding and hemorrhage from smaller 
vessels. 

Why is the actual cautery not a safe hemostatic in case a 
larger artery is cut 9 

Because the blood pressure against the eschar is greater 
than the adhesive qualities of the eschar. 



12 PRINCIPLES OF VETERINARY SURGERY 

Why should the actual cautery he employed at a didl-red heat ? 
At a wliite lieat the escliar formed is completely car- 
l)onized and would not stick ; when a black heat is applied ta 
the parts the eschar formed will adhere to the cautery. 

Describe the use of cold and heat as a hemostatic. 

Either one produces contraction and coagulation, but is; 
of use only in hemorrhages from small vessels and oozing- 
from larger surfaces. 

What remedial agents — that is, styptics — are employed in the' 
arrest of hemorrhage, and hoiv do they act ? 
These chemicals when brought into immediate contact., 
with tlie bleeding part, produce coagulation and contraction 
of the vessel. They are either applied directly to the parts, 
or a tampon is saturated with them and held against the- 
bleeding surface by some comjDressing agent. Modern 
surgery objects to their use, as they form a repugnant clot,, 
favor infection, and act as an irritant. Those more fre- 
quently employed are : tannoform, tannic acid, alum, vinegar- 
a.nd tincture of iron. 

What constitutional treatment is indicated in hemorrhage f' 
Unless an exhaustive hemorrhage occurred, rest is all 
that is required. In serious bleeding, rest, the application of" 
heat to the body surface, and stimulants and the infusion of' 
a normal saline solution per rectum, or in very urgent cases, 
intravenously^. In cases of internal bleeding, where the- 
leaking vessel cannot be secured, the best agent is fld. extr.. 
hydrastis canadensis. 

Describe hemophilia. 

A congenital tendency to persistent hemorrhages frona. 
the slightest wound. 



THE HEALING OF WOUNDS 13 



Jn wliat animal has hemophilia been seen ? 
It has only bei n observed in the horse. 



THE HEALING OF WOUNDS. 

Name the vainous modes of repair by which destroyed tissues 
are replaced. 

(1) Healing by first intention {per primam intent ionem) ; 
•(2) by second intention (per secundam intentionem) ; (3) by 
third intention {jjer tertiam intentionem); (4) healing under a 
scurf ; (5) abnormal granulation and cicatrization. 

Define healing 2)ef primam intentionem. 

A primary union by cementing of the wound edges 
without pus formation. 

Under whcd conditions is primary union most likely to occur ? 
When the hemorrhage is arrested, bloodclots and foreign 
T^odies removed (dirt, hair, splinters, tissue shreds), when the 
wound is aseptic or rendered so, when the edges are smooth 
•and straight and closely aj^proximated, and when the wound 
is protected by an antiseptic dressing against secondary 
infection. 

What kind of wounds may be readily healed by first intention 
in animals 9 

Surgical wounds, provided an antiseptic protective dress- 
ing can be applied. 

Describe the macroscopic changes seen in healing by first 

intention. 

First, the edges of the wound are united by blood, to be 

"replaced by the so-called wound cement (a lymphoid plas- 

Tmatic liquid). About the second day the edges are red. 



14 PRINCIPLES OF VETEPJNAEY SURGERY 

painful and somewhat swollen. In about one week per- 
manent union takes place, with a little cicatrix at the sit© 
of incision. 

Describe the microscopical changes in healing by first intention^ 
White blood cells emigrate from the neighboring vessels. 
and invade the edges and wound cement. This cellular 
infiltration is due to the traumatic irritation of the parts, and 
is not the result of the presence of bacteria, as is the case in 
healing by second intention. In healing by first intention it. 
is an expression of reaction by the injured tissues, while in 
healing by second intention it represents a purulent inflam- 
mation. The greatest number of leucocytes in the wound, 
edges are met with on the third day ; after that they either- 
return to the blood vessels or die. 

Describe the process of cicatrization. 

The fibroblast produces the scar tissue. These are- 
roundish cells which arise through proliferation of the- 
endothelial cells of the vessels and those connective tissue 
cells which are present. The fibroblasts increase in size, and 
epithelioid, spindle and club shaped cells form ; these again 
change into fibrillar connective tissue cells, which in turn 
form the scar tissue proper. Vascularization of the wound 
edges takes place at the same time, the new vessels being 
formed by a process of budding from the walls of the cut 
capillaries. The young tissue formed by the fibroblasts plus; 
the newly created blood vessels is termed granulation tissue, 
which shrinks as soon as the fibroblasts change into con- 
nective tissue cells, the capillaries close, at which moment, 
scar tissue proper is formed. The last step in healing by 
first intention consists in the skinning over of the scar tissue,, 
the cells springing from the epithelial cells upon the edges. 



THE HEALING OF WOUNDS 15 

Define healing by secundam intentionem. 

The filling of a wound- gap by granulations with pus 
formation. 

What tvounds usually heal by second intention ? 

All those where the fundamental principles upon which 
the healing by first intention is based have been disregarded. 
Therefore, infected wounds, those with wanting close approxi- 
mation of the edges, contused wounds, etc. 

'Describe the macroscojjical changes seen in healing per 
secundam. 
During the first forty-eight hours the various tissues can 
be recognized ; at this time the surrounding neighborhood 
begins to swell, is reddened, exhibits increased heat and pain. 
About the second day the wound surface looks gray, due to a 
thin layer of coagulated plasma coming from the cut lymph 
vessels. During the next few days swelling and pain increase 
some more, the wound surface having a jelly-like, grayish- 
red look . About the fourth day the discharge from the wound 
is yellowish and opaque ; at this time the coagulated plasma 
resting upon the wound surface breaks up and, together with 
necrotic tissue shreds, is carried away in the wound discharge; 
now little red points are seen everywhere provided the wound 
is first cleansed by irrigation. The fifth to sixth day these 
red points, which are granulations, have grown higher and 
are covered with thick grayish-yellow pus. Up to the eighth 
day these granulations become larger, so as to fill the gap 
between the wound edges pretty well. About the eighth day 
the wound surface decreases and the edges approximate. 
Whenever the granulations are even with the level of the skin 
the granulating surface becomes smooth and glistening and 
no further granulations are formed. Next, the periphery of 



16 PKINCIPLES OF VETEEINARY SURGERY 

the wound shows a dry pinkish seam moving toward the 
centre of the granulating surface, being followed by a bluish 
dry seam upon the pigmented skin ; this process continues 
until the whole granulating surface is skinned over. 

Describe the microscopical cJianges in healing by second 
intention. 
On the whole there is but little difference in those 
observed in healing per primam and those per secundain 
intentioneni. The main point of difference lies in the fact 
that on account of the presence of pus-producing cocci decided 
Irritation of the tissues is produced, as a result of which large 
numbers of leucocytes emigrate. Otherwise the infiltration 
of the wound edges, the formation of fibroblasts, vasculariza- 
tion — that is, the budding of the capillary vessels — the chang- 
ing of the fibroblasts into fibrillar connective tissue, is in no 
wise different from healing by primary union. 

Define healing by third intention. 

It consists in the union of two suppurating granulating 
surfaces. 

What steps are necessary to secure healing per tertiam ■? 

Absolute disinfection of the granulating surface with 
perfect coaptation of the wound edges held in place by an 
exact suture. 

To 'what extent is healing per tertiam applicable ? 

It is a most valuable method and should always be 
attempted, to bring about rapid and permanent union. 

How long after the primary injury occurred, may healing per 
tertiam be possible ? 
To avoid ugly scars — for instance, about the head of 
valuable horses — a wound of a week's standing can be healed 
by third intention. 



ABNOKMAL GRANULATIONS 17 

Define healing under a scurf. 

This is a form of healing by first intention, by exsciccat- 
ing the blood upon the wound by means of chemical agents, 
as the result of which a firm adhering scab representing an. 
aseptic dressing is produced. 

Hoiv does healing under a scab tal-e place ? 

The new epidermis is supplied by the epithelial cells 
along the edges of the wound, these young ex)ithelial cells 
being x^rotected by the artificial scurf. 

Why is healing under a scurf of importance ? 

At times neither suturing nor bandaging the wound is 
possible, the scab then taking the place of an aseptic dressing. 

What agents are mainly employed to produce a dry scab? 

By dusting the wound with tannoform, tannic acid, 
iodoform, aristol, europhen, xeroform. 



ABNORMAL GRANULATIONS AND 
CICATRIZATION. 

Under what circumstances is the normal process of granulation 
and cicatrization likely to become abnormal ? 

In wounds with decided loss of tissue, presence of foreign 
Ibodies, continuous irritation and infection of the parts under- 
going healing, certain systemic disturbances. 

Define caro luxurians. 

It represents excessive and rapidly growing granulations, 
commonly termed proud flesh. 



18 PKINCIPLES OF VETERINAEY SURGERY 

What part of the body is mainly exposed to exuberant 
granulations ? 

All those where the healing process is interfered with by 
more or less continuous irritations, as wounds in the flexion 
surface of the hock, pastern ; here the continuous flexion and 
extension irritates the wound. Also in fistula of the withers 
and saddle pressures when necrotic tissue is located at the 
bottom of the wound, thus irritating the parts constantly ; 
also in muscular hernia, nicely seen in deep peroneal neurec- 
tomy when the muscles protrude from an incision made into 
its surrounding aponeurosis ; here the pinching of the parts 
by the slit in the fascia keeps up the irritation. 

Name some other forms of abnormal granulations. 
Torpid, irregular, weak, pale. 

What are erethistic granulations ? 

Those which bleed very easily, are dark-red and very 
irritable and painful. 

Explain coagulation necrosis of granidation tissue. 

Following obstruction of the capillary vessels by inflam- 
mation or their imperfect development, the wound is covered 
with a diphtheritic-like membrane representing death of the 
upper layers of the granulation. 

When is a cicatrization likely to become abnormal ? 

In wounds with great loss of substance cicatrization 
becomes incomplete and the result is an ulcer, or the scar 
shows an undue accumulation of cornified epidermic cells. 

What is a keloid 9 

A hard fibrous growtli ari-iii;;" i i a scav. 



EEGENEKATION OF TISSUES 19^ 

Which is their favorite locality 9 

In the liorse, tliey are usually seen in tlie flexion surface 
of the pasterns, following barb wire cuts or a brush burn 
(rope or halter burn), and around the coronary region 
following calking. 

How may excessive scar contraction ajfect a part ? 

The great contractile power of the cicatricial tissue in 
extensive scars by puckering up the tissues surrounding the 
original wound may produce decided deformities, as in larger 
injuries of the eye-lid it may become everted (ectropium). 



BEGENERATION OF THE VARIOUS TISSUES. 

How does the regeneration of the skin and mucous membrane 
take place 9 

As described under "The Healing of Wounds." The 
epidermis and epithelium of mucous membranes are rapidly 
replaced. 

How do muscular wounds heal ? 

The power of regeneration of muscles is very limited, 
only taking place in slight injuries, the rule being a connec- 
tive tissue scar in a muscle wound. 

How do te7idon wounds heal ? 

Cells are thrown out from the tendon sheath and sur- 
rounding tissue ; the granulations tlius formed invade the 
blood-clot which at first was created between the two ends of 
the tendon. This clot is absorbed, the granulation tissue 
unites the ends of the tendon and is gradually changed into 
connective tissue until it is finally difficult to tell the difference 
between the new and the old tendon fibres. 



'20 PRINCIPLES OF VETERINARY SURGERY 

How do hone wounds heal ? 

Same as fractures, tlirongli an ossifying granulation 
tissue, involving tlie periosteum, bone, and marrow (see the 
^' Healing of Fractures "). 

How do cartilage u^ounds heal ? 

By proliferation of the perichondrium. In the wound is 
first seen a fibrous deposit, which later changes into an ossify- 
ing callus. When proliferation of the perichondrium starts, 
new cartilaginous tissue is also formed by cartilage cells 
adjoining the wound, while those cartilage cells close to the 
cartilage wound undergo fatty degeneration. 

How do peripheral nerves heal 9 

The powers of regeneration of peripheral nerve tissues 
are good. Provided the ends have been united artificially, 
new nerve fibres formed by the old nerve fibres of the central 
stump grow into the peripheral stump. A club-shaped swell- 
ing (fibroneuroma) forms at the end of the central stump, 
chiefly due to a growth of the neurilemma, when the ends of 
the cut nerve are separated by a distance of half to one inch 
'(often seen in neurectomy). 

HoiD do ivounds of the brain and spinal cord heal ? 

Here no regeneration of the nerve substance occurs, but 
~a connective tissue scar forms. 

How do ivounds of non-vascular tissues, as the cornea and 
articidar cartilage, heal ? 
It resembles the healing of vascular tissues. Leucocytes 
-emmigrate from sclera and conjunctiva, followed by cell 
proliferation of the fixed cells, with formation of fibroblasts, 
^nd then change into connective tissue, but vascularization 
springs from the adjoining sclera. In articular cartilage, the 



TRAUMATIC INFECTIOUS DISEASES 21 

scar, wliicli at first is made up of connective tissue, may be-^ 
changed in time into liyaline cartilage. 



TRAUMATIC INFECTIOUS DISEASES. 

What are traumatic infectious diseases 9 

They comprise a number of accidental wound diseases,, 
due to the entrance of bacteria or their products (toxines) into- 
the wound. 

Name the most imjjortant traumatic infectious diseases 9 

(1) Traumatic fever, (3) septicaemia, (3) pyaemia, (4) sup- 
puration of the wound, (5) cellulitis. 

In a wider serise of the tuord, ivhat other diseases belong to the 
traumatic infectious disease 9 
Tuberculosis, anthrax, glanders, malignant oedema,,, 
actinomycosis, botryomycosis, etc. 



SUPPURATION OF THE WOUND. 

Name the cause of wound suppuration 9 

Suppuration is the result of an inflammation caused by 
the infection of the wound by pus cocci. 

Name the most important pus producing bacteria 9 

The most common pus coccus is the staphylococcus, 
pyogenes aureus, most frequently met with in circumscribed 
localized processes. Experiments show that subcutaneous 
injections of this germ usually cause an abscess; intravenous 
injection produces pyaemia and ulcerating endocarditis; intra- 
peritoneal injections cause a fatal suppuration ; 2, the less. 



22 TRINCIPLES OF VETERINARY SURGERY 

common staphylococcus pyogenes albus; 3, staphylococcus 
pyogenes citrius; 4, streptococcus pyogenes; this and the first 
one are the most important ones; it is especially concerned in 
the production of progressive phlegmonous suppurations. 

What is 2)us 9 

The material which forms as the result of suppurative 
inflammation. 

Describe healthy and laudable pus ? 

It is represented by a yellowish-white odorless alkaline 
thick creamy liquid which does not coagulate. 

What is ichorous pus ? 

Pus which has undergone decomposition produced by the 
presence of micro-organisms of j)utrefaction. 

What is sanious pus ? 

It is pus undergoing decomposition plus blood. 

By what is the quantity and quality of pus influenced f 

It depends on the consistency and vascularity of the tis- 
sues, the size and age of the wound, the kind and number of 
pus cocci, the time of the year, temperature, climate and 
species of animal. 

Describe the constituents of pus. 

When pus is allowed to stand in a vessel, two layers cari 
be seen. 

The upper one is thin and slightly yellowish, and is 
termed pus serum (Liquor puris). It contains an albuminous 
substance called peptone and salts in about the same propor- 
tion as the blood. 

The second layer or sediment is composed of pyogenic 
cocci, possibly other bacteria, tissue shreds and pus cor- 
puscles, red blood cells, droplets of fat. 



CELLULITIS 23 

WJiy does pus not coagulate 9 

On account of the absence of fibrinogen, wliich. has been 
changed into an albuminous substance (peptone) by the pus 
cocci. 

WJiat taJces place when the suppurative process does not con- 
fine itself to the u-ound but spreads to the surrounding 
tissues ? 
A diffused form of suppuration of the connective tissue 
is termed a phlegmonous inflammation. When the lymph 
vessels undergo inflammation, it is called lymphangitis ; the 
"veins, phlebitis. When pus cocci and their toxines (poisonous 
alkaloidal substances developed by bacteria) enter the general 
circulation, surgical fever, pyaemia and septicaemia may 
set in. 



CELLULITIS. 

Define cellulitis ? 

It is an infectious, mostly suppurative inflammation of 
the cellular tissue, and may be subcutaneous, submucous, 
subfacial, intermuscular, periosteal, perichondreal, tendo- 
vaginal, etc. 

What other name is employed to designate cellulitis 9 
Phlegmonous inflammation. 

Name the causes of infectious or suppurative cellulitis. 

Most frequently the staphylococcus pyogenes aureus and 
streptococcus pyogenes enter the wound. 

What kind of wounds predispose to cellulitis 9 

Deep, punctured, contused, lacerated ; very often the 
wound is small or even closed when cellulitis sets in. 



24 PEINCIPLES OF VETERINARY SURGERY 

What is metastatic cellulitis ? 

The pus cocci after entering the wound do not remain irk 
the wound, but are carried to other parts by the lymph 
current. 

What varieties of cellulitis are recognized ? 

It may be superficial or deep, circumscribed and diffused;: 
from an anatomical standpoint, it may be interglandular^ 
intermuscular, subcutaneous, etc. 

Which is tlie most malignant form of cellulitis ? 

Septic cellulitis. It represents a mixed infection by pus^ 
cocci and septic bacteria. 

What is gaseous cellulitis ? 

It is a mixed infection, gas being produced by gas forming 
bacteria (Bacillus phlegmonse emphysematosse, bacterium. 
coli). 

What is a specific cellulitis ? 

One produced not by pus cocci but by an individual defi- 
nite bacillus, as in malignant oedema. 

In wliat animals is cellulitis usually met with ? 

Most frequently in the horse, next in the dog, and then in 
the ox. 

What forms of infectious cellulitis are the inost common ones? 
The most frequent form is the subcutaneous one, while in 
the horse, at least, snbfacial, intermuscular, perichondreal 
and tendovaginal cellulitis is often seen. 

Which forms of infect io^is cellulitis are of practical interest f" 
1. Subcutaneous cellulitis about the head and hind legs, 
of horses (lii)S, eyelids, intermaxillary space). 



CELLULITIS 25 

2. Siibmucoiis cellulitis of the mouth and pharynx, as 
stomatitis, phlegmonous glossitis and pharyngitis. 

3. Subfacial cellulitis, as in fistulous withers, poll evil 
and punctured wounds about the legs. 

4. Intermuscular cellulitis, involving muscles of the 
neck, shoulder, legs, abdomen and croup. 

5. Subcoronary cellulitis (coronary calking). 

G. Perichondreal cellulitis about the lateral cartilage, as 
in quittor. 

7. Cellulitis of the plantar cushion from nailpricks. 

8. Cellulitis of the tendon sheath of the flexor tendons 
(horse). Subcutaneous and intermuscular cellulitis of the 
tail — in horses, following myotomy; in cattle, from inocula- 
tions (anthrax, blackleg). 

9. Cellulitis of the prepuce and scrotum in the horse 
after castration. 

10. Cellulitis of the mammary gland in cattle. 

Describe circumscribed cellulitis ? 

Inspection reveals a swelling over a Timited skin area. 
This swelling may stop abruptly, same as seen in purpura 
hemorrhagica. Unless deeply pigmented, the skin over the 
swelling is red, apjDears stretched and glistens. Palpation 
shows heat, pain, the j^arts being hard, soft or doughy. The- 
skin over the swelling cannot be wrinkled. 

How does circumscribed infectious cellulitis terminate 9 

It may terminate in (1) an abscess; here the skin looks 
greasy, bluish, red or blackish ; palpation shows fluctuation. 
There may be fever. The contents of the abscess may reach 
the external world spontaneously. A part of the skin over 
the abscess undergoes necrosis, allowing exit of the pus. 
Unless opened artificially, the pus may burrow, leading to (2) 
a diffused purulent cellulitis. 



26 PRINCIPLES OF VETEEINAEY SUEGERY 

Name some of the sequels to suppurative circumscribed eel- 
hilUis. 

Phlebitis, lymphangitis, lymphadenitis, septicaemia and 

pyaemia. 

Describe diffused cellulitis. 

Besides extensive swelling of the skin and fever there is 
decided pain expressed by lameness when the locomotory 
apparatus is involved. Subfacial cellulitis expresses itself by 
more or less fever and great pain. Being deeply situated, 
the skin over the diseased parts either does not show anything 
abnormal or some slight cedematous doughy swelling. The 
above also applies to intermuscular cellulitis. 

What course does diffused s^qopurative cellulitis talie ? 

There is a decided tendency to necrosis of skin, fasciae, 
muscles, etc., or death from septicaemia or pyaemia. 

Describe septic cellulitis. 

It is very acute in its action and spreads like wildfire, 
with high septic fever. On stroking the diseased parts a 
peculiar crepitation is sometimes felt, due to formation of 
gases from decomposition (septic emphysema). Its course is 
rapid and usually fatal. 

How do the various forms of infectious celliditis terminate ? 
This depends on their extent and character and the 
animal species. It may terminate in : 

1. Resolution, quite common in circumscribed cellulitis 
and in that form commonly known as lymphangitis (Monday 
morning disease, seen in the hind legs of horses). 

2. Abscess, met with in all forms of cellulitis ; when 
superficially located there is but little danger, while the sub- 
facial and intermuscular abscesses are often unfavorable. 



CELLULITIS 27 

3. Necrosis, likely to be seen in all forms of cellulitis. 
Mortification of the diseased tissues is -mainly observed in 
septic, subfacial, intermuscular, perichondreal cellulitis, as 
poll evil, fistula of tlie withers, quittor. Septicaemia and 
pyaemia are often sequels. 

4. Encapsulation of the abscess. The abscess becomes 
enclosed by a capsule, so to speak, and remains dormant ; 
most frequently seen in intermuscular cellulitis. A common 
example is the shoulder abscess in the mastoido humeralis of 
the horse. By and by the capsule gives way and another cel- 
lulitis attack takes place. This possibly explains the inter- 
mittent attacks of diffused subcutaneous cellulitis (lymphan- 
gitis, Monday morning disease, milk leg) so often seen in the 
hind legs of horses. 

5. Chronic enduration. Sclerosis is often seen after 
repeated attacks of diffused septic cellulitis in hind legs of 
torses, representing a chronic connective tissue proliferation 
and leading to enormous thickening of the skin (elephantiasis). 
Such a chronic connective tissue proliferation involves also 
subfacial, intermuscular, perichondreal tissues. 

Qive the treatme7it of infectious cellulitis. 

As long as the presence of an abscess is not established, 
tot antiseptic sponging, irrigations and fomentations must be 
employed. As soon as possible the abscess should be opened, 
sloughs removed and the cavity irrigated with antiseptics and 
thorough drainage provided. The acute cellulitis of the 
torse's hind legs is combatted by purgatives. The best 
treatment of to-day consists in the hypodermic use of are- 
coline or intravenous use of collargolum with an external 
camphor treatment of the leg. 



28 PKINCIPLES OF VETEKINARY SURGERY 



TRAUMATIC FEVER. 

Describe its nature and causes. 

It represents a constitutional disturbance accompanied "by 
various symptoms, as increased body temperature, increased 
pulse rate, changes in the composition of the blood, changes 
in the distribution of the blood, disturbances of the nervatory, 
digestive and respiratory apparatus. Fever following non- 
infected wounds is termed aseptic fever, explained by the 
absorption of broken down bits of tissue, blood clots, effused 
serum, which are known to have a pyrogenous action (fever- 
producing). Fever following infected wounds is termed septic 
or bacterial fever, also intoxication-infection fever, explained 
by the absorption of chemical poisons (toxines) of the wound 
secretion , the result of the action of pyogenic micro- 
organisms. 

How is the generation of traumatic fevers explained ? 

The exact origin of fevers is still somewhat dark. Never- 
theless it appears that the heat centre in the brain produces 
and regulates calorification. Experiments have shown that 
irritation of the heat centre causes a rise of temperature, 
while paralysis of the centre is followed by a sinking of the 
body temperature. Irritation of the heat centre may be 
produced by the action of chemicals, as mallein, tuberculin, 
argenti colloidalis, albumoses, toxines, etc., while a depres- 
sing influence is exterted upon the heat centre by such 
chemicals as antifebrin, anti]3yrin, etc. Traumatic fevers, 
therefore, in the light of modern science, probably depend on: 
the irritation of the heat centre by the absorption of poisonous 
chemical products contained in the wound secretion. 



SEPTICEMIA 29 

Describe the symptoms of traumatic fever. 

(1) Rise of temperature. This may be slight when not 
exceeding 103 F.; moderate np to 104.9 F.; high up to 106 .7 F. 
Its course is usually atypical, continuoiis or remittent, and 
rarely intermittent. 

(3) Constitutional disturbance, only marked in high 
fevers expressed by psychical depression, disturbed heart 
a-ction, wanting appetite, irregular state of the bowels. 

Give the treatment of traumatic fevers. 

The essential feature is thorough disinfection of the 
wounds, absolute drainage, counteropenings to allow contin- 
uous evacuation of pus. Abscesses must be incised early and 
the infected granulations of the abscess wall removed by 
curetting or otherwise, followed by application of antiseptics. 
As a rule no internal treatment is necessary. Should internal 
antiseptics be indicated, camphor, quinine, alcohol, and in 
cattle also turpentine are the best known means. 



SEPTICAEMIA. 

Define septicceTnia. 

It is a traumatic infectious disease, due to the introduc- 
tion into the blood tissues of certain bacteria and their j)ro- 
ducts of metabolism without the presence of localized internal 
affections, but such generalized changes as swelling of the 
spleen, cloudy swelling of the kidneys, liver, heart, etc. 

What two main forms of septiccEmia are recognized ? 

(1) Bacterial septicaemia, due to the presence of bacteria 
and transferable to other animals by blood inoculation. 

(2) Septic intoxication, due to the presence of chemical 
poisons (toxines), not transferable to other animals by blood 
inoculation. 



30 PRINCIPLES OP "VETERINARY SURGERY 

Name the most important microorganisms concerned in the 
production of hacterial septicoe,mia. 
Streptococcus septicus and pyogenes, staphylococcus 
aureus, micrococcus tetragenous, the bacilli of mouse and 
rabbit septicaemia, bacillus enteritidis, bacterium coli. 

How ivould you classify anthrax, blackleg, malignant oedema. 

and septiccemia hemorrhagica 9 

Each of these diseases represents a " specific septicaemia/* 
Describe septic intoxication. 

A type of septicaemia due to the absorption of poisonous 
products of metabolism of bacteria. These products of meta- 
bolism are chemical poisons of an alkaloidal nature and are 
known as ptomaines, toxines, etc., entering the general cir- 
culation from some necrotic focus about the body (skin> 
intestines, lungs, etc.). 

What bacteria are of interest to the surgeon in septic intoxica- 
tion 9 

Those enumerated under " Bacterial Septicaemia." 
What is saprc£mia 9 

A type of septic intoxication depending on the absorption 
of products of metabolism of saprophytes, as proteus mira- 
bilis vulgaris and zenkeri . 

Define kryptogenetic septiccemia. 

A septicaemia the cause of which is not detectable. 

Describe the essential post-mortem changes of septiccemia. 

Blood thin and tarry ; all organs show great tendency to 
decompose. Subserous and submucous hemorrhages, espe- 
cially envolving endocardium and mesentery. The voluntary- 
muscles and heart muscle appear as if boiled, having a clay 



SEPTICEMIA 31 

color ; spleen, kidneys and liver usually swollen. Sometimes 
there is parenchymatous and hemorrhagic nephritis, also 
catarrhal, hemorrhagic and diphtheritic enteritis ; also ulcer- 
ating endocarditis. The "wound may or may not be in an 
extremely septic state (diffused cellulitis spreading along the 
lymphatics) . 

The microscopical examination of the blood reveals num- 
erous microorganisms of some form or other with a decided 
breaking down of the blood corpuscles, the white ones espe- 
cially representing enormous aggregation of bacteria. 

Give the symptoms of septiccEmia 9 

The wound may or may not show septic cellulitis. The 
constitutional symptoms are moderate or high fever up to 
107 F. and more ; this high temperature is occasionally 
ushered in with a chill ; the pulse is very rapid and small, 
later imperceptible. The animal is drowsy and very weak ; 
trembling of the shoulder and gluteal muscles, even paralysis 
of the hindparts ; mucous membranes icteric, or dark red 
faeces, at first juicy, later mushy and finally diarrhceal, with 
colicky pains ; urine dark ; its chemical analysis shows 
albumen. 

Infected icounds of what parts are often folloived hy septi- 
ccemia in the horse ? 
Purulent inflammation of tendon sheaths and articula- 
tion, as also deep and extensive subfacial and intermuscular 
cellulitis, terminating in death in a few hours to several 
days; occasionally the disease drags along two to three weeks. 

How do you treat septiccBmia 9 

Absolute disinfection of the whole wound surface; remove 
slonghs; provide drainage; deep recesses which cannot be 



32 PRINCIPLES OF VETERINARY SURGERY 

drained should be irrigated with antiseptic solution. Make 
Jong and deep incisions where fluctuation is present ; in 
subfacial and intermuscular cellulitis, inject quantities of 
slightly warmed glycerine 10, iodoform 1 part. The in- 
ternal treatment is of little value ( excepting intravenous 
injections of soluble silver) ; nevertheless, stimulate with 
fearless doses of strychnine, digitalis ; give tonic doses of 
quinine, also camphor. 



PYiEMIA. 

Define pycBtnia. 

A traumatic infectious disease, due to the absorption of 
pyogenic microorganisms into the circulation with multiple 
or metastatic abscesses in different portions of the body. 

What bacteria are of interest in pycemia 9 

Practically all those which are productive of septicaemia, 
especially the streptococcus pyogenes and the staphylococcus 
pyogenes aureus. 

How do these bacteria enter the general circulation ? 

There is first the infected wound ; the microorganisms 
multiply, may come in contact with a vein, the vein becomes 
inflamed as the result (phlebitis), and a thrombus is formed 
at this point ; this thrombus undergoes puriform softening, 
and a piece of it is swept away into the general circulation, 
this little piece of broken down thrombus now being termed 
embolus, and since it contains bacteria it represents an 
infected embolus ; this embolus is carried along by the blood 
until it reaches a bloodvessel having a smaller diameter than 
its own. Here the embolus stops ; the bacteria which it con- 
tains now multiply and an abscess follows. In this manner 
abscesses develop in the various portions of the body. 



PYEMIA 33 

Wounds of which i^art of the hochj predispose to pycBmia ? 

In the liorse, wounds about tlie coronary region; in calves 
and colts, the umbilical region of the newly born; otherwise 
bone wounds. 

What do you understand by septicopyc2mia ? 

This disease is a combination of pysemia and septicaemia. 

Describe the essential post-niorteni changes of pycsniia. 

The essential features are purulent, inflammatory foci of 
internal organs, as liver, lungs, spleen, kidneys, joints, tendon 
sheaths, heart, muscles, etc. A purulent inflammation of the 
synovial membrane of the joints is of special importance in 
navel ill of the colt (polyarthritis pysemica). Purulent 
inflammation of the serous membranes is also seen (peri- 
toneum, pleura, meninges), also purulent inflammation of the 
eye (purulent choroiditis). Occasionally circumscribed hem- 
orrhages uj^on the serous membranes and those pathological 
changes peculiar to septicaemia, then septicopysemia. At the 
point of origin the veins are filled with a decomposing 
thrombus (purulent thrombo-phlebitis). 

Give the symptoms of pyc^mia. 

After the wound is undergoing the process of healing and 
suppuration established, a very irregular intermittent fever, 
sometimes ushered in with chills, is observed. Multiple sub- 
cutaneous abscesses may appear suddenly here and there or 
symptoms of a metastatic pneumonia or those peculiar to 
abscesses of the liver, kidneys, brain, or serious lameness due 
to pyaemic polyarthritis or tendovaginitis. 

What is the duration of pycE,mia 9 

Longer than that of septicaemia, from several days to 
weeks, depending on the extent and location of the metastatic 



34 PRINCIPLES OP VETERINARY SURGERY 

lesions. Occasionally the course is chronic, with great emacia- 
tion of the animal. Pyaemia is a very dangerous disease, but 
less fatal than septicaemia. 

The period of reconvalescence is very prolonged. 

How do you treat pycemia ? 

Stop the progress of the disease by disinfection, not only 
of the wound, but, if possible, of the interior of the vein, 
provide drainage, making long and deep incisions wherever 
indicated. The internal treatment is of little use, but quinine, 
camphor and strychnine are indicated. Of all agents, intra- 
venous injections of Crede's soluble silver salt are likely to 
give the best results. 



SPECIFIC TRAUMATIC INFECTIOUS DISEASES. 

Malignant CEdema. 

Define malignant oedema 9 

A traumatic infectious disease, due to the entrance of the 
bacillus of malignant oedema and probably others into the 
subcutaneous or submucous connective tissue. 

What kind of u'ounds are favorable to the development of the 
adema bacillus 9 

Punctured wounds permitting entrance of earth dust into 
the subcutaneous or submucous connective tissues. Here the 
oedema bacillus thrives, as the proper medium is present and 
above all an absence of oxygen. Injury to the tongue or 
oesophagus by foreign bodies, hypodermic injection impro- 
perly made, operations with dirty instruments ( empiric 
castrations). 



SPECIFIC TRAUMATIC INFECTIOUS DISEASES 35 

Give the symptoms of malignant oedema. 

High fever ; a rapidly spreading oedema about tlie in- 
fected wound. The swelling when stroked with the hand or 
finger emits a fine crepitus, feels doughy and is very painful 
at the circumference, but cold and painless at the centre. 
The sloughing tissues are surrounded by a thin, putrid fluid; 
the discharge is sanious and foul smelling. Further, symp- 
toms of enteritis and pulmonary dyspnoea. The rapidly 
spreading gangrene with the presence of an emphysemic 
oedema are pathognomic. 

Name the salient post-mortem changes of malignant oedema. 

The subcutaneous tissue is infiltrated with a lemon- 
colored jelly, the surrounding muscles likewise, emitting also 
the foul odor of putrefactive gases. The fluid flowing from 
the parts is yellowish red, foams slightly and is of putre- 
factive odor. There is severe inflammation of the gastro- 
intestinal mucous membrane, also pulmonary oedema, but no 
swelling of spleen. 

Hotv does malignant oedema terminate 9 

As a rule, by death in one to three days ; very rarely, by 
abscess formation and recovery. 

How do you treat malignant oedema ? 

Deep incisions, removal of all sloughs, antiseptic irriga- 
tions, drainage. 

Tetanus. 

A specific, traumatic, infectious disease, caused by the 
action upon the central nervous system of the strychnine-like 
toxin of the tetanus bacillus. 



56 PRINCIPLES OF VETERINARY SURGERY 

What ivounds are favorable to tetanus infection ? 

"Wounds inflicted in dirty parts of the body, as tail, hoof, 
scrotum, vagina, umbilicus, etc. ; punctured wounds, espe- 
cially nail pricks, coronary caulks, amputation and myotomy 
of the tail, setoning, castration. 

What animals are subject to tetanus ? 

Mainly the horse ; next, lambs and pigs ; then, rarely, 
■cattle and goats. The dog seems to be almost immune. 

Which are favorite places of the tetanus bacillus ? 

Rich garden earth, land manured with horse manure, 
street dust. 

What do inoculation experiments shoio ? 

The most common form of infection is through earth, 
while, of course, foreign objects, as nails, splinters, dirty 
instruments, etc., may convey the bacillus. It does not enter 
the blood current, but localizes in the wound and produces a 
strychnine-like toxin (Tetanotoxalbumin), which on being 
absorbed acts upon the central nervous system, giving rise to 
certain symptoms. 

Give the essential post-mortem changes of tetanuSi. 
Evident pathological changes are usually absent. 

Hoiv long is the period of incubation f 

Three to twenty days. 
Give the symytoms of tetanus ? 

These vary somewhat with the intensity of the intoxica- 
tion. There is a tonic spasm, especially of the extensors of 
the hind extremities, neck and masticatory muscles. Ears 
erect and stiff, eye partly covered by the nictitans, tail 
elevated and stiff ; saliva flows from the mouth ; lips some- 



SPECIFIC TRAUMATIC INFECTIOUS DISEASES 37 

■what retracted ; the whole body appears extended and th& 
points of both hocks are turned out ; the walk is stiff, the 
animal mainly supporting weight with the toe region of the 
hoof. By raising the head the eye is retracted and tha 
membrana nictitans falls forward over the eye. The mouth 
cannot be opened (trismus). Respiration is labored and from 
20 to 50 or more per minute ; the pulse in unfavorable cases 
runs from 50 to 70. Temperature, as a rule, is but little 
elevated. The animal is easily excited. 

What is ortliotonos ? 

That type of tetanus where the vertebral column forms a 
straight horizontal line. 

What is opisthotonos ? 

That form of tetanus where the head is elevated and th& 
region of the back curved downwards. 

What is pleuTosthotonos ? 

That form of tetanus where the vertebral column is. 
curved to one side. 

What type of tetanus is practically the only one seen in the 
horse 9 
Orthotonos. 

What is the termination of tetanus ? 

In the most acute form, death in one to three days ; in 
the acute form, death in four to ten days ; in the subacute 
and chronic form, death after several weeks or recovery in 
20 per cent, of all cases. 

What does the prophylaxy of tetanus include ? 

Antiseptic treatment of all wounds and the injection of 
antitetanic serum, previous to or immediately following the 
injury. 



38 PRINCIPLES OF VETERINARY SURGERY 

How do you treat tetanus 9 

Keep the animal in a quiet and dark place. The applica- 
tion of slings is of doubtful value in the horse. Thorough 
disinfection of all wounds, even the slightest ones. Inter- 
ternally, chloral hydrate, bromide of potassium, fld. extr. 
gelsemium, fld. extr. calabar bean, atropia, injections of 
tetanus antitoxin. Internal medication in tetanus, to say the 
least, is unreliable. 

What is the rate of mortality in tetanus 9 
Between 70 and 80 per cent. 

What other infectious diseases may follow traumatism 9 

1. Wound diphtheria (Gangraena nosocomicalis) repre- 
sents a coagulation necrosis of the granulations of a wound, 
due to the action of a specific bacillus. In the croupous and 
diphtheritic form the granulations change into a yellowish, 
purulent necrotic mass; in the ulcerous form the granula- 
tions change into a grey, mushy necrotic mass ; in the 
pulpous form the granulations are changed into a stinking, 
decomposing, tarry, granular mass. 

3. Glanders. Primary skin glanders very rare ; infection 
takes place about the head, extremities, along the belly, etc. 
The glanders ulcers develop out of the infected wound. 

3. Rabies. 

4. Symptomatique anthrax. 

5. Anthrax. 

6. Wild plague. 

7. Tuberculosis. 

8. Botryomycosis. 

9. Actinomycosis. 



THE TREATMENT OF ^YOUNDS 3^ 

THE TREATMENT OF WOUNDS. 

What two forms of wound treatment are recognized ? 
The aseptic and antiseptic methods. 

What does the aseptic method consist of 7 

It is of nse only in fresh aseptic germ-free wounds made 
by the snrgeon. Such a wound does not come in contact 
with any antiseptics at all. It is dried with sterilized 
tupfers, possibly irrigated with boiled water, and finally 
dressed with a sterilized dry dressing. 

To what extent is the aseptic method of wound treatment 
applicable in veterinary surgery ? 
In every-day practice it is not to be thought of. Most 
wounds are old and infected or fresh and infected. The sur- 
roundings are such that even should the desire exist to do 
aseptic work, it simply cannot be executed. Aseptic treat- 
ment of wounds can be best demonstrated at the colleges, but 
to the average practitioner it only exists in theory. 

Outline the antiseptic treatment of -wounds. 

This includes the production of a reasonably germ-free 
state of the resting-place of the patient, or at least field of 
operation of the wound, hands and arms of the operator, 
instruments and dressings, and preventing subsequent infec- 
tion by antiseptic dressings. 

1. Resting-place of the animal. — The operation can be per- 
formed anywhere. Either have a straw bed or what is the 
best bed imaginable, one made up of a two to three inch 
thick layer of southern pine shavings. Just previous to the 
casting of the animal the bed is sprinkled with a 1 per cent, 
carbolic acid or permanganate of potash solution. Under- 



40 PRINCIPLES OF VETERINARY SURGERY 

neatli the field of operation a clean rubber sheet is placed. 
This rubber sheet is of great practical interest, as it protects 
the field of operation against the invasion of bacteria from 
beneath, enabling the surgeon to operate almost anywhere. 
The hospital and college go one step further toward asepsis, 
by providing operating tables — practically, useless; theoreti- 
cally, ideal. The latest is Dollar's operating table. This 
mechanical contrivance upsets the mental equilibrium of any 
but the most decrepit old horse. The vast majority of horses 
cannot be gotten near it; those which you get into it almost 
invariably raise all sorts of disturbances before they are 
secured with the foot-chain, belly-strap, etc. In city practice 
it may be allowed to exist, but the country practitioner's 
experience with it on farmers' horses, which are but half 
broken anyway, would make quite a collection of broken 
bones of the head, fore and hind legs, to say nothing of the 
crushed fingers coming from the surgeon's anatomy. 

After an operation, to prevent secondary infection tho 
animal is prevented from lying down by tying him short. 
(Castration wounds in city practice; equally valuable in 
country practice, unless a dust and mud free pasture is given 
as a run.) 

2. Field of opera^io?^,— Shave the parts; scrub with 
Park & Davis's mercury soap; rinse the parts with bichloride 
of mercury solution 1 : 500, and cover with a towel soaked in 
a bichloride of mercury solution 1 : 500 till the operation can 
be started. 

3. Hands of the operator. — Remove dirt mechanically 
with brush, soap (P. & D. mercury soap) and warm water. 
Pay CO s e attention to the finger nails. After scrubbing both 
hands and arms with soap and water for some minutes, scrub 
them once more in a 1 : 1000 bichloride of mercury solution 



THE TREATMENT OF WOUNDS 41 

and rinse tliem in water that has been boiled. (Now do not 
stick tliem into your pants pockets, readjust a rope or touch 
anything but the instruments or field of operation. ) 

Instruments. — Boil the instruments for ten minutes in a 
1 per cent, carbonate of sodium solution, then place them in 
a shallow tray filled with a three per cent, carbolic acid 
solution. 

Dressings. — Sponges are hard to sterilize and should be 
replaced by gauze tupfers. At the same time they are hard 
to replace, as they soak up the discharging fluids so readily. 
They are best prepared as follows: After dusting them 
thoroughly, soak them for some hours in a permanganate of 
potasium solution (8 grains to 1 pint of water). ISText wash 
them repeatedly in boiled water. Then place one dozen 
sponges into one gallon of water containing dissolved one- 
half pound of hyposulphite of sodium and add four ounces of 
oxalic acid; leave them in this solution ten minutes; next 
pack them away permanently in a three per cent, solution of 
carbolic water. Gauze tupfers are simply boiled for half an 
hour and then placed in a three per cent, carbolized solution 
for future use. 

Bandages are best boiled and then kept soaked in a 
1:1000 formalin solution. 

Ligatures. — Silk is boiled half an hour and then kept 
soaked in a one-half per cent, formalin solution. Sterile cat- 
gut is best bought, as its production is rather troublesome. 

A very convenient apparatus for the sterilization of 
knives, dressings, etc., is a formaldehyde sterilizer. 

What features should the antiseptic drug possess ? 

It must have sufficient power to promptly destroy strep- 
tococci and staphylococci. In this strength it must not 
irritate the tissues and interfere with the process of healing. 



42 PRINCIPLES OF VETERINARY SURGERY 

It must not "be jjoisonous to the system wlien absorbed. It 
must be reasonable in price. 

Name the antiseptics of special importance to veterinarians. 

Heat, bicliloride of mercury, formalin, carbolic acid, 

creolin, protargol, iodoform, tannoform, zinc chloride, aristol. 

What wounds do you dress and bandage 9 

All those which by the proper nse of antiseptics have 
become aseptic, in order to protect them against the further 
invasion of pyogenic or specific bacteria. 

When do you use a dry and when a moist dressing ? 

"Wounds which suppurate freely or secrete freely, other- 
wise those with cellulitis of the neighboring tissues, are 
given a moist antiseptic dressing. Parts yet to be operated 
and to be disinfected previous to the operation are also given 
a moist antiseptic dressing. (Hoof, in preparing for a quittor 
operation ; the metacarpal region previous to a neurectomy.) 

How often should a bandage be changed 9 

It is not to be disturbed unless dislocated or unless the 
animal shows pain, fever or increasing swelling of the 
injured parts, when the bandage becomes soiled by pus or 
wound discharge. The odor arising from a bandage is not 
always a deciding feature for changing it. 

Under what circumstances is an open wound treatment 
indicated 9 
Whenever the state of the wound or the part of the body 
prevents the application of a dressing. Under these circum- 
stances an attempt is made to replace the regular dressing by 
producing artificially a firmly adhering scab on the wound 
surface. 



THE TREATMENT OF SPECIFIC WOUNDS 43 

Outline the treatment of luounds in general. 

1. Stop the hemorrhage by compression, ligation or 
torsion (heat, actual cautery and styptics) . 

2. Do not probe with instrument or finger unless you are 
sure that no septic material is carried into the wound by 
doing so. Remove all foreign bodies whenever possible ; 
pick them out with an artery forceps, wash them out with a 
stream of bichloride of mercury solution. In cases of lacera- 
tion or contusion look upon the torn tissues as beyond repair 
and remove them with the scissors. Clean the wound by 
scrubbing its neighborhood with P. & D. mercury soap, cut 
off all hair along its edges and if possible shave the edges. 
Wash out the wound with some antiseptic solution (bichloride 
of mercury 1:500), ridding it of all bloodclots, etc. 

3. Drainage, closure and dressing. — All infected wounds 
must be drained, also large and deep ones. For that purpose 
Tise gauze strips or oakum strands. Deep, lacerated and con- 
tused wounds when infected ought not to be closed by 
sutures, but the "open wound treatment" is best instituted. 
Superficial wounds which can be asepticized and those which 
are aseptic should be sutured. In suturing a wound, avoid 
excessive tension, as the circulation of the parts is interfered 
"with by it, leading to sloughing. Wherever possible, apply 
an antiseptic dressing. 



THE TREATMENT OF SPECIFIC WOUNDS. 

Describe the treatment of a fresh incised wound. 

Arrest the hemorrhage, but do not use styptic agents if 
it can be avoided ; remove all foreign bodies ; clean the 
wound by antiseptic irrigations. When superficial, no 
drainage is necessary ; otherwise drain at the most dependent 



44: PRINCIPLES OF VETERINARY SURGERY 

part. Suture in a waj to secure perfect apposition of the 
wound surfaces ; or, if tlie amount of skin permits, bring- 
the edges together, evert them, and run the sutures over the 
skin-ridge thus formed. Excessive tension upon the wound 
edges can often be materially lessened by dissecting the skin, 
from the subcutaneous tissue all around the wound for 
several inches. Whenever possible, apply a dry or moist 
antiseptic dressing. When no bandage is applicable, dust 
the wound with tannoform or tannic acid, or when sutured 
paint it with wound gelatin. 

Describe the treatment of a fresh punctured wound. 

Most wounds of this sort in animals are infected. The 
leading point in the treatment of perforating wounds is. 
drainage, if necessary, by counter openings, and thorough, 
disinfection. Get pent-up effusions out of the way. Remove 
foreign bodies (nails or splinters broken off in the wound). 
Hemorrhage, as a rule, is of little importance. Should a 
larger vessel be injured, try compression, and if that is. 
insufficient, enlarge the wound and ligate the artery or vein. 
In punctured wounds about the hoof the horn surrounding 
the puncture must be pared thin and the horn immediately 
around the opening removed ; then the nail tract is to be 
disinfected, followed by a warm antiseptic fomentation. 

Describe the treatment of lacerated and contused luounds. 

As a rule there is but limited hemorrhage. When larger 
vessels are injured they should be tied. To avoid secondary 
hemorrhage all shredded tissue must be removed Here 
primary disinfection is of vital importance, as the vitality 
of the wound is impaired. All wound recesses must be 
made accessible to drainage, if necessary by counter-openings. 
Coaptation of the wound surfaces by suturing is, as a rule> 



THE TREATMENT OP SPECIFIC WOUNDS 45 

not indicated. Active local antiseptic treatment, to encourage 
separation of sloughs, to prevent septic complications, are 
essential. For tliis purpose, warm, moist antiseptic dressings 
frequently changed, and, above all, constant irrigation, are 
valuable. 

Describe the treatment of old and suppurating wounds. 

The rules laid down for " lacerated and contused wounds" 
■are applicable. Suppurating wounds about the head as old 
as one week may be healed by third intention as follows : 
Dress the wound with sweet oil, scrub it clean with P. & D. 
mercury soap; remove all shreds; irrigate with 1:500 bi- 
chloride of mercury solution (use several quarts) ; freshen the 
edges; coaptate the wound surface absolutely with aseptic 
silk and cover with dry antiseptic dressing. 

Drescribe the treatment of gunshot wounds. 

When the hemorrhage is intense, ligate the proximal and 
distal ends of the vessel, if necessary enlarging the wound 
sufficiently to get to it. Do not probe with the finger or 
probe unless the entrance of the wound indicates that some 
septic material (piece of the harness, saddle, blanket, etc.) 
has been carried along; those wounds demanding exploration. 
l>ecause of extensive lacerations or destruction of vital parts 
can be probed, as the creature is usually doomed. It is not 
necessary to probe for the missile unless it interferes with the 
process of healing. Should the projectile become a source of 
irritation subsequently after healing is well established, it 
xnay then be removed with proper surgical precautions. 
Ordinarily, unless the wound is extensive, disinfect it and its 
surroundings and apply an antiseptic dressing. Extensive 
wounds and those manifestly septic are best given the open 
Tvound treatment. The wound tract should not be disturbed 



46 PRINCIPLES OF VETERINAEY SURGERY 

unless evidences of inflammatory disturbances set in. Should 
they appear, then exploration, drainage, counter openings 
and disinfection become imperative. 

Describe the treatment of poisoned luounds. 

The stings of wasps, bees, hornets, yellow jackets are^ 
best treated with alkaline solution, as bicarbonate of sodium 
solution; internally, stimulants. Snake bites of the rattler^ 
viper, copperhead, highland and water moccasin are treated 
by ligating the whole part if possible, and when seen early 
incise the wound freely and inject with the hypodermic- 
syringe into the wound and surrounding tissues a 1 per cent^ 
aqueous solution of permanganate of potash ; internally,, 
give alcohol and digitalis freely. 

Describe the treatment of ivounds ivith abnormal granulations^ 
Excessive granulations are removed by the knife, scissors; 
or curette, and kept in check by astringents and pressure- 
bandage, provided its application is possible. Sulphate of 
copper, chloride of zinc, and a mixture of tannoform and 
alum (equal parts) and the actual cautery are reliable. 

Describe shin grafting. 

It consists in transplanting bits of the epidermal layer of 
the skin, with the strictest of aseptic precautions, to granu- 
lating wound surfaces which on account of their extent 
cannot skin over by the ordinary process of healing. 

Is shin gi'afting practical in animals ? 

It is not, — mainly on account of the great mobility of the 
parts and the limited blood supply of the skin. 



CONTUSIONS 47 

CONTUSIONS. 

Define a contusion. 

An injury due to pressure by a blunt body, rending 
asunder subcutaneous tissue elements, but without a visible 
skin wound. 

Differentiate between a contused wound and a contusion. 

Ill a contused wound there is a primary visible infected 
cutaneous wound. In a contusion there is no primary visible 
infected wound. The distinction between them is one of 
degree and not of kind. 

Name causes of contusions 9 

In the horse, saddle and harness pressure about the back, 
breast and head; in the hoof by shoes and crowding nails; 
blows, falls, etc. In cattle, blows from horns ; and in the 
dog, bites, blows. 

According to the extent and severity of the subcutaneous 
lesions, tuhat degrees of contusion are recognized 9 

1. Contusion of the first degree. Limited hemorrhage, 
the bruised tissues are uniformly infiltrated by the extrava- 
sation (hemorrhagic infiltration), or the extravasation ac- 
cumulates in small circumscribed patches (ecchymosis, sug- 
gilation). 

2. Contusion of the second degree. The effused blood 
collects in a subcutaneous cavity and forms a blood tumor 
(hematoma). When the blood effusion spreads over a 
diffused area it is termed a suffusion. 

3. Contusion of the third degree. The bruised parts 
undergo necrosis, not as the direct result of the bruising, but 
due to (1) circulatory disturbances caused by the injury to 
the blood vessels, this process being termed primary anemic 



48 PRINCIPLES OF VETERINARY SURGERY 

necrosis ; (2) secondary septic necrosis following the entrance 
of infectious agents. 

4. Contusion of tlie fourth, degree. Complete pulpifica- 
tion of the contused parts. 

Describe the microscopical changes in bruised tissues. 

Slight contusions exhibit a tearing of the smallest blood 
vessels and their accompanying delicate loose connective 
tissue. In more serious bruises the intercellular substance is 
ruptured, pushing the cells apart. Destruction of the cells 
themselves, even in most serious contusions, is seldom 
observed. 

How does the microscopic study of contused tissues prove that 
the contusion per se cannot be looked upon as the direct 
cause of necrosis ? 
It shows that while the intercellular substance may be 

torn, the cells themselves remain intact, preserving their 

vitality, thus power of regeneration. 

How do contusions terminate 9 

Termination differs according to their extent, location, 
degree, presence or absence of infection. They terminate by 
(1) resorption, (3) organization, (3) necrosis. 

Describe the process of resorption. 

Occurs in contusions of the first degree. The extrava- 
sation is taken up by the lymph vessels. First the coagulum 
squeezes out the serum which enters the lymph vessels; next, 
the coagulated fibrin becomes liquefied and is absorbed; then 
the white blood cells and finally the red ones disintegrate and 
enter the circulation. 

Describe the process of organization. 

Seen in more extensive extravasations, especially hema- 



CONTUSIONS 49 

toma. As a result of the proliferation of the fixed tissue cells 
about the peripheral neighborhood of the hematoma, a cellu- 
lar infiltration with subsequent formation of fibrillar connec- 
tive tissue forms, eventually replacing the extravasation 
(this process is closely related to organization of a thrombus). 
Should the newly formed connective tissue not permeate the 
hematoma, but this chronic aseptic inflammatory process 
confine itself to the periphery, a connective tissue membrane 
encapsulating the extravasation is the result. This cyst 
formation is commonly seen in dogs. 

Describe the process of necrosis. 

Here the suppuration is due to the entrance of pathogenic 
bacteria into the blood extravasation. Diffused hemorrhagic 
infiltrations are likely to lead to septic cellulitis ; the hema- 
toma is changed into an abscess ; septicaemia and pyaemia 
may become sequels. 

Describe the symptoms of a contusion. 

There is always more or less sudden swelling except in 
deep subfacial or intermuscular bruises, where three to four 
days may pass before the soft fluctuating hematoma shows. 
Hemorrhagic infiltrations are somewhat hard to the touch. 
In the first few days there is no oedematous, doughy, hard, 
painful peripheral swelling ; in fact, this is usually peculiar 
to an abscess. Later on the contused area becomes harder, 
fluctuation disappearing as the serum is absorbed and re- 
placed by cellular elements. Excoriation of the skin over 
the area of contusion may be seen. Depending on the locality 
of the contusion, impaired or lost function is apparent : thus, 
lameness, difiQcult mastication, apprehension of food, par- 
alysis, contusion of nerves, spinal cord, insensibility from 
contusion of the brain. 



50 PRINCIPLES OP VETERINARY SURGERY 

Give the constitutional symptoms following contusion. 

As a rule there are none. In case a large blood vessel is 
torn, the symptoms of acute anaemia present themselves. A 
rise of temperature is observed after extensive contusions 
(aseptic fever, due to the absorption of pyrogenous material). 
When contusions become complicated with suppurative pro- 
cesses the symptoms peculiar to them are present (necrosis, 
septicaemia, pysemia). 
Give tJie differential diagnosis of contusion swellings. 

Abscess. Hard and painful in the beginning, developing 
gradually, with late fluctuation ; peripheral area oedematous 
and doughy. 

Hematoma. Soft and early fluctuation ; sudden and 
complete development ; no peripheral oedema, at least not 
during the first few days. 

Abdominal hernia. Contents of tumor are compressible; 
the muscular rent can usually be located by palpation. 

In case any doubts exist, the contents of the swelling 
may be revealed by an aseptic puncture of the same. 
Describe the treatment of contusions. 

As a rule rest is important. In the slighter and super- 
ficial contusions, evaporating lotions, massage, or warm, 
moist antiseptic compresses, provided they can be applied, 
are useful ; otherwise, warm antiseptic bathing. 

Those contusions with considerable disorganization of 
tissues demand a treatment which will promote the activity 
of the local circulation, break up and diffuse the bloodclots 
and serous effusions and hasten absorption. Here warm 
moist antiseptic dressing or bathing, according to the region 
involved, are imperative. After four to five days the most 
dependent part should be freely opened, all recesses exposed 
to drainage, the cavity packed with antiseptic tampons, to 



CONTUtJlONS Oi 

"be removed at regular intervals to allow tliorough. irrigation 
of the parts. 

Those contusions with necrosis of the tissues and sup- 
purative cellulitis must be treated according to the rules 
already laid down, namely, removal of sloughs, absolute 
drainage and continuous disinfection as far as it is possible 
from a practical and economic standpoint. 

The treatment of blood cysts consists in excision. 

Which contusions are of practical interest ? 

1. Those involving the withers, saddle region, point of 
the shoulder and sternum. 

2. Hematoma of the croup and hind leg. 

3. Contusions by the twist (lips); commissures of the lip 
by badly fitting headstall or from pulling ; interdental space 
from the bit in pullers. 

4. Contusions about the external angle of the ilium and 
about the eyes, due to rolling and tossing about, as in painful 
colics. 

5. Bruises over the atlo axoid regions. 

6. In the dog, along the neck and back, internal ear 
surface, from pinching bites. 

7. Bruises about the elbow (shoeboil). In the dog, over 
the ischiatic tuberosity. 

8. Bruises over the anterior carpal region, as in horses 
that paw and hit the knee against the manger, or in cows that 
are kept on hard floors and kneel a great deal ; in horses, on 
the internal aspect of the knee and shin from interfering. 

9. Bruises about the os calcis, as in horses which kick the 
stall partition. 

10. Bruises of the sensitive parts of the hoof (podo- 
phyllous membrane), producing a hemorrhagic pododerma- 
titis, vulgarly termed corns. 



52 rKINCIPLES OF VETERINARY SURGERY 

SUBCUTANEOUS RUPTURES. 
Ruptures of Muscles. 

Name the causes of muscle rupture. 

Follows violent muscular contractions, or by the action 
from without of blunt agents. Occurs mainly in young 
animals and racehorses. 

What muscles seem to he predisposed to lacerations ? 

Flexor metatarsi, the straight, oblique and transverse 
muscles of the abdomen, the crural triceps, gastrocnemius, 
gluteal muscles, biceps brachii, biceps femoris, triceps ex- 
tensor, mastoido humeralis, longissimus dorsi, psoas, postea 
spinatus, etc. 

What do you understand by spontaneous rupture of a muscle? 
The tearing of muscles which have undergone pathologi- 
cal changes, as in animals exposed to prolonged high fevers. 

Describe the symptoms of muscle rupture. 

The most important one is impaired or lost function, 
depending on the fact whether the rent is complete or partial. 
The torn muscle, being no longer antagonized by its 
antagonist, has full play, followed by symptoms peculiar to 
each case. In very recent cases it may be possible to feel the 
space between the retracted ends, which it must be remem- 
bered is soon filled by a blood clot and extravasations. 

Hoiu do muscle lacerations heal ? 

The blood clot is absorbed. The cells from the internal 
and external perymisium proliferate until the two ends are 
united by connective tissue. The ultimate damage, as a rule, 
is never great. 



SUBCUTANEOUS RUPTURES 63- 

Describe the treatment of muscle rupture ? 

Rest is essential ; stimulating liniments, even blisters. 

What do you understand hy hernia of a muscle 9 

The protrusion of a muscle through a rent of its envelop- 
ing fascia. 

Rupture of Tendons. 

Name the causes of tendon rupture. 

The same as in rupture of a muscle. Sometimes it fol- 
lows spontaneously after prolonged rest, especially in animals 
which suffered with contagious pleuropneumonia or morbus 
maculosus. 

How may tendon ruptures be classified 9 

Spontaneous (following prolonged rest, necrosis, inflam- 
mation); complete (involving the whole tendon); partial 
(where only some of the fibres of the tendon are torn). 

What tendons of the horse are most frequently involved in 
complete rupture 9 
Flexor pedis perforans and perforatus, flexor metatarsi,, 
superior sesamoidal ligament, tendo achilles, extensor pedis. 

Which in the cow and dog 9 

Flexor metatarsi and tendo achilles. 
Which is the most common tendon rupture of the horse 9 

Flexor metatarsi, and flexor pedis perforans in the 
foreleg. 

Describe the process of healing of tendon rupture ? 

After the blood has been absorbed the connective tissue 
scar is formed by the interfascicular connective tissue, para- 
tendineum and tendon sheath. 



54 PRINCIPLES OF VETERINARY SURGERY 

A very important point, especially from the practical 
standpoint of operative surgery (tenotomy), is that the round 
cells of the original granulation tissue change into spindle- 
shaped cells by the tension upon the tendon wound by the 
muscles and weight of the body. In other words, early and 
regular tension plays an important role in the process of 
healing of such injuries. Another point of practical interest 
lies in the fact that lacerations within a tendon sheath do not 
heal as quickly as those outside of it, for the reason that the 
more loose connective tissue is present (as is the case in 
injuries outside of a tendon sheath), the more rapid the 
process of healing, since the greatest part of the new tissue 
comes from the paratendineum. Aseptic injuries necessarily 
heal more kindly than infected ones. Because the pus 
opposes regeneration, the infected parts slough off, which in 
these tissues requires some time ; in between times free pro- 
liferation occurs by the paratendineum, and more or less 
severe thickening of the parts results. 

What are the common complications of tendon rupture ? 

In the aseptic form, some thickening of the parts and 
contraction ; in the septic form, decided thickening of the 
parts, contraction, and in case the tendon sheath becomes 
infected, cellulitis, septicsemia. 

Describe the treatment of tendon rupture. 

Attempt approximation of the parts and maintenance of 
the same by compression, plaster of paris cast, rest. In 
septic wounds, disinfect ; and should the tendon sheath be 
involved, drain. Prevent excessive granulation of the sur- 
rounding soft parts by astringent antiseptic compresses 
(tannoform) until sequestration of the necrotic masses has 
taken place. Any thickening may be treated subsequently 



INFLAMMATION 55 

by the actual cautery and blisters. In dogs, one may try to 
suture the torn tendon. 

Give the symptoms of tendon rupture. 

Vary greatly with the tendon involved. There are 
always functional disturbances, as excessive volar or dorsal 
flexion. A gap may be felt and seen, increasing on exten- 
sion (flexor tendon) or on flexion (extensor tendon). 



INFLAMMATION. 

Define inflammation. 

Inflammation, not being a definite disease, cannot be 
defined. It represents the response of tissues irritated by an 
injury with a highly complicated reactive process. 

What are the phenomena of inflammation ? 

1. A reflex vasomotor paresis producing a dilatation of 
the arteries, veins and capillaries of the inflamed tissues. 

2. Followed at the same time by a great increase in the 
rapidity of the flow of blood (hypersemia), succeeded by a 
slowing and finally stopping of the blood current. 

3. Concurrently with the slowing of the blood current 
the white blood corpuscles begin to line up and crowd along 
the vessel's wall (especially the veins), the red cells continuing 
to flow along the centre of the blood current. This condition 
is followed by the emigration of the white blood corpuscles 
into the surrounding tissues (diapedesis) from the interior of 
the veins through the walls of the vessel in the direction of 
the irritating element (chemiotaxis), which represents the 
condition commonly termed ''cellular infiltration of the 
inflamed tissue." 



56 PEINCIPLES OF VETERINARY SURGERY 

4. As the result of tlie altered condition of tlie walls of 
tlie blood vessels a more or less abundant transudation of liq. 
sanginis escapes from tbe dilated blood vessels, to wbicb is 
added the emigration of red blood cells from the capillaries, 
these two representing the main cause of the so-called 
"inflammatory swelling." 

5. The proliferation of the fixed connective tissue cells 
together with the emigrated white blood corpuscles are 
actively concerned in the production of the so-called "cellu- 
lar infiltration of the inflamed tissue." 

Causes of Inflammation. 

Give a practical classification of the causes of inflammation. 

1. Aseptic (mechanical, thermal, chemical). 

2. Septic (due to the influence of pathogenic micro- 
organisms). 

Enumerate some of the most important causes of inflammation. 

1. Mechanical irritations, as contusions, wounds, pres- 
sure, laceration, etc., produce a traumatic inflammatory 
process. It is aseptic in healing by first intention, subcu- 
taneous tendon and muscle ruptures, in that form of podo- 
dermatitis commonly termed founder ; finally, in all inflam- 
mations of a non-infectious nature of articulations, bones, 
bursae, tendons, etc. 

2. Thermic irritations, as heat and cold. 

3. Chemical irritants, as the application of vesicants, the 
action of acids or alkalies, the subcutaneous injection of 
certain agents, followed by a purulent inflammation without 
the presence of pus producing bacteria, in such pus as creolin, 
ammonia, turpentine. 



INFLAMMATION 57 

What is the cause of an infectious inflammation ? 

The entrance of pathogenic micro-organisms into the 
tissues. 

What classes of bacteria are more coywtnonly concerned ? 

Staphylococci, streptococci, baciUus of tuberculosis, 
malignant oedema, anthrax, glanders, etc. 

Hoiv do these bacteria cause inflammations ? 

These micro-organisms do not irritate the tissues mecnani- 
cally, but become phlogogenous by their chemical uroducts 
of metabolism (toxines). 

What is phlogosin ? 

A cry stalliz able chemical of a phlogogenous nature, first 
obtained from staphylococci cultures by Leber. 

Varieties of Inflammation. 

According to the exudate, what varieties of inflammation are 
hnown ? 

Serous, fibrinous, purulent, hemorrhagic, gangrenous,, 
diphtheritic, productive, specific. ■ 

Describe serous inflammation. 

In this type of inflammation the walls of the blood vessels-- 
are but slightly altered, the exudate is watery, lymph-like,, 
and contains but few white and red blood cells. It is more^ 
common in the skin, upon the mucous membranes and serous 
membranes of articulations, tendon sheaths, etc. 

Describe fibrinous inflammation 9 

Also known as croupous inflammation, the exudate- 
abounds in fibrin and white blood cells. When the exuda- 
tion cells and the newly formed cells of such an inflamed 



58 PRINCIPLES OF VETERINARY SURGERY 

tissue are caught in a fine reticulum of fibrin, this membrane- 
like covering of the inflamed . tissue is termed a fibrinous 
pseudo-membrane. Fibrinous inflammation is most fre- 
quently met with upon the serous membranes of articulations, 
bursae, tendon sheaths and mucous membranes. 

Describe purulent inflammation. 

Usually the result of an infection with pus cocci. The 
accumulation of pus may be circumscribed or diffused. 

What is an abscess ? 

A newly formed cavity circumscribed by granulation 

tissue and containing pus. 

What is a purulent infiltration ? 

It is a diffused collection of pus in inflamed tissues. 
What is empyema ? 

An accumulation of pus in the sinuses of the head or 
articulations, etc. 

Describe hemorrhagic inflammatioii. 

In this form of inflammation the walls of the vessels 
in the affected tissues have undergone material alteration 
and the exudate contains a great many red blood corpuscles. 

Describe gangrenous inflammation . 

One of the most malignant types. The exudate is putrid, 
discolored and undergoing decomposition due to the presence 
of putrefactive bacteria. 

Explain diphtheritic inflammation. 

This represents a coagulation necrosis of the mucous 
membrane, followed either by the formation of a diphtheritic 
pseudo membrane upon the mucous membrane or loss of 
tissue in the necrotic parts. 



INFLAMMATION 59l 

Define coagmaiion necrosis. 

It means local death of cells clue to wanting nutrition, 
Tvith subsequent disintegration of these cells and their change 
into a substance resembling coagulated fibrin. 

JExplaiii lyroductive inflammation. 

A chronic process leading to and followed by tissue 
proliferation. Depending on the nature of the produced 
tissue, this type of inflammation may be fungous, endurating, 
granulous, verroucous, adhesive, etc. 

Explain sijecific inflammation. 

Inflammations due to the action of specific agents, as 
glanders, tuberculosis, actinomycosis, botryomycosis. 

Symptoms of Inflamm.ation. 

Name the cardinal symptoms of inflammation. 

Redness, heat, pain, swelling and impaired function. 
Sow is inflammatory redness (rubor) explained ? 

Pigmentation of the skin and the hairy coat of animals 
as a rule interferes with the ready demonstration of redness, 
while it is easily observed on the white skin and mucous 
membranes. Rubor is due to the dilated state and excessive 
accumulation of red blood cells in the blood vessels. 

How is the increased heat {color) of the parts explained ? 

There is no increase in the local production of heat 
within the inflamed tissues, this depending mainly upon the 
increased flow of blood to the parts. 

Sow is the swelling (tumor) of the parts explained ? 

By the dilatation of the vessels and inflltration of the 
tissues by the exudate. 



60 PEINCIPLES OF VETERINABY SURGERY 

« 

Describe ihe quality of svcli a swellijig. 

This varies with the nature of the tissues involved. Ife. 
may be of doughy consistency, pitting on pressure, best seen 
in the loose subcutaneous tissue along the abdomen, due to 
the presence of serum in the tissue meshes, termed inflam- 
matory oedema. Swellings due to the accumulation of blood 
corpuscles or proliferating, fixed connective tissue cells are- 
harder and do not pit on pressure because these elements are- 
not as readily displaced by pressure from without. This. 
form of swelling is termed plastic or cellular infiltration. 

Explain the presence of pain in an inflamed part. 

Following the swelling there is an increase of pressuro- 
within the inflamed organ which in return means a bruising- 
of the sensitive nerves of that part. At the same time it is, 
probable that the nerves themselves undergo inflammatory 
changes. The greater the nerve supply, the greater the. 
swelling, and the less the inflamed part is capable of ex- 
panding, the greater the pain : for instance, in the skin». 
pododerm, eye, articulations. 

HoiD does impaired function express itself ? 

Lameness due to an inflamed muscle, which is rigid and 
contracted. The special senses may be impaired by the^ 
inflammatory process, and inflamed gland stops to produce- 
its natural secretion. 

Course and Termination of Inflammation. 

Classify inflammation according to the rapidity and intensiif^ 
of its course 9 
1. (a) Peracute ; duration only a few hours, as malignanfe 
cedema, anthrax. (6) Acute ; here the process sets in with a. 



INFLAMMATION 61 

<decided activity to reacli its climax within a few days or 
weeks, (c) Subacute ; duration one to two weeks. 

2. Clironic. The inflammatory process is sluggish, pos- 
sibly extending over years. 

Depending on the extent, what forms of inflammation are of 
interest ? 
Superficial (external skin, mucous membranes and serous 
membranes); deep or parenchymatous, subdivided into inter- 
^stitial and parenchymatous ; in the former, the inflammation. 
takes place in the interstitial connective tissue ; in the latter, 
it involves the parenchyma of the organ, as muscle fibres, 
glandular cells. The inflammation may be localized or cir- 
cumscribed and progressive or diffused. 

-Name the more important terminations of inflam.mafion. 

(1) By resolution ; (2) by production ; (3) by necrosis. 
.Describe the termination hy resolution. 

Here the inflammatory exudate is absorbed by the lymph 
vessels with the assistance of the white blood cells. 

Describe the termination by production. 

Instead of the part returning to its normal condition 
^thout appreciable alteration of its tissues, as is the case in 
'*' resolution," inflammatory new growths follow the inflam- 
matory process, as adhesions, thickening, seen, for instance, 
iu elephantiasis, exostoses, chronic grease (dermatitis ver- 
rucosa), etc. 

Explain termination by necrosis. 

Gangrene of the inflamed parts is due to severe inter- 
ference with the circulation or septic infection. The dead 
tissue is separated from the living by suppuration, the line of 
<lemarcation indicating the place where the separation which. 



62 PRINCIPLES OP VETERINARY SURGERY 

occurs gradually takes place. Healiug, after the slough has 
separated, takes place by granulations. 

The Treatment of Inflammation. 

How do you treat inflammation f 
Locally and constitutionally. 
Describe the local treatment of inflammation, 

1. Remove the cause. This is the most important feature^ 
T^oreign bodies must be removed, an ill-fitting bit corrected,, 
any undue pressure from the harness or shoe corrected, etc. 

2. Give rest to the inflamed part. This in itself often 
suffices to produce a cure. Thus the inflamed eye must be^ 
protected against light, a distorted joint kept at rest, tha 
foundered hoof kept quiet, etc. 

3. All wounds must be disinfected to prevent septie 
inflammations or inhibit their spreading. 

4. The inflammatory process itself must be acted upon to> 
limit itself in extent and intensity, etc., looking toward the 
removal of the exudate and healing of the diseased state 
of the walls of the vessels in the inflamed territory. 

Describe the means employed for the modification or arrest of 
inflammatory processes. 
(1) Cold, (2) heat, (3) compression, (4) drugs, (5) surgical 
interference . 

Sow does the action of cold influence the inflci,mmatorif 
processes 9 
It contracts the dilated blood vessels, restricts tlie exuda- 
tive processes (emigration of the white blood cells, hemor- 
rhage), abstracts the increased heat of the inflamed part, 
depresses the functional activity of the sensitive nerves, thus 
easing pain. 



INFLAMMATION 63 

Describe the application of cold for the relief of inflammatory 
processes, 

1. By immersion. The diseased part is placed into a 
vessel with cold water, a fresh supply of cold water being 
added from time to time to get the action of continuous cold 
(the latter being done away with in case the parts are 
immersed in a flowing stream, as a brook, etc.) This method 
is practically confined to the treatment of inflammatory states 
of the hoof. 

2. Cold fomentations. Consists of the application of 
some absorbent material, as cloths, bandages, etc., kept moist 
with cold water. This method is not very effective unless the 
dressing is moistened every five minutes. Experiments have 
shown that the temperature of the parts drops during the 
first two to three minutes, to rise to within the original 
temperature shortly ; at best the temperature can be kept 
down when cold is applied every five minutes, which lowers 
the temperature permanently some 5 to 9 degrees F. In 
these cases the addition of such agents as vinegar, alum, 
lead acetate, disinfectants (as carbolic acid, chloronaphtho- 
leum, formalin, etc.), is of twofold value : they influence 
acute inflammatory processes favorably, prevent infections 
and ease the mind of the owner, as the mere use of cold 
water may seem insufficient to him. 

3. Continuous irrigation. This represents undoubtedly 
the most valuable means of applying cold. It consists in 
allowing a thin stream of cold water with or without the 
addition of medical agents to flow continuously over the 
diseased part. Experiments have shown that by this method 
the temperature of the irrigated part dropped about 36 deg. 
F. after one hour's irrigation. 



64 TRINCIPLES OF VETERINARY SURGERY 

When is the application of cold contraindicated in the treat- 
ment of inflammation f 
It is only of use in the earlier stages of acute inflamma- 
tion. It should not be emiDloyed in infectious states, as it 
interferes with the process of healing by inhibiting the 
exudative process more or less, the latter being a vital factor 
in the process of repair. It should not be used in the treat- 
ment of serious bruises, as the vitality of the parts is already 
lowered by the contusion, and thus sloughing would be 
encouraged by the application of cold. In other words, there 
are few inflammatory processes which could be treated suc- 
cessfully by the application of cold after the inflammatoi-y 
processes once existed 36 to 48 hours. 

How does the action of heat influence the inflammatory 
p)rocess. 
Temperatures ranging from 78 to 122 deg. F. dilate the 
blood vessels, thus increasing the blood-flow and increasing 
nutrition of the parts. As a direct result of this, absorption 
of the exudation is encouraged. Heat softens and renders 
less tense tlie inflamed tissues ; consequently, pain is more or 
less relieved. 

Describe the application of heat in the treatment of inflam- 
mation. 

1. By immersion. The part is immersed in warm water, 
a new supply being added from time to time to keep up the 
desired temperature. 

2. Cataplasms. Linseed meal, bran, etc., is mixed with 
warm water containing some antiseptic agent, as one-half per 
cent, carbolic acid, etc.; or, better, cotton waste (such as 
is used to wipe machinery) is soaked with a warm antiseptic 
solution and applied to the inflamed part. These have to 



INFLAMMATION 65 

he renewed every three to four hours to be of any A^alue. 

The best results are obtained by the so-called Priessnitz 

fomentation. 

Describe the Priessnitz fomentation. 

A cloth of an absorbent nature is dipped into cold water 
and wrung out. This cloth or bandage is applied to the 
diseased part. Over it are wra})ped several layers of woolen 
material. In cases which warrant the expense, a layer of 
oiled silk or some other impervious article is applied, before 
the last woolen bandages are placed. The whole thing is 
removed and reapplied every four to six hours. 

Describe the action of the Priessnitz fomentation. 

The application of the cold dressing produces a temporary 
-contraction of the underlying blood vessels, followed by a 
■decided dilatation of them. The moist cloth or bandage soon 
becomes warmed by the parts with which it is in contact, and 
since the overlying woolen layers prevent the evaporation of 
heat, the temperature of the surface skin next to the moist 
dressing reaches body temperature. By changing the Priess- 
nitz every three to six hours the blood vessels are induced to 
contract and dilate, thus vitalizing the parts, materially 
encouraging the reparative processes— that is, the breaking 
down and absorption of the inflammatory exudates. 

During what stages of infiaTYi'mation is heat indicated ? 

In all subacute and chronic forms ; whenever the vitality 
of the parts is low ; where there is great tension ; where sup- 
puration is present ; when sloughs are to be separated. 

When is the application of heat contraindicated ? 

At the very outset of inflammation, in cases of septic 
cellulitis and malignant oedema, as these pathological pro- 
cesses are encouraged by the action of heat. 



66 PKINCIPLES OF VETEEINAKY SURGERY 

How does compression influence the inflammatory process ? 

Compression is beneficial by promoting absorption and 
resolution, done by changing the rate of circulation suffi- 
ciently to bring about rapid absorption and normal nutrition.. 
By compression, inflammatory exudates are diffused, tissues 
loosened bound down by adhesions. 

What methods of compression are employed in the treatment 
of inflammation ? 

1. Continuous compression, as by bandaging the part. 

2. Intermittent compression, as by massaging the parts 
with the hand or fingers. 

To u'liat extent is massage of value in animals ? 

Massage is a very valuable means in the treatment of 
subacute and chronic aseptic inflammations. Its application 
is limited in animals, because it should be used from one to 
three times daily for five to fifteen minutes each time. The 
presence of the hairy covering renders it less effective in 
animals — in fact, interferes with the proper execution of 
it. The pressure to be exerted upon the painful parts renders 
the animal intractable. Therefore it is confined to the treat- 
ment of chronic inflammations in valuable horses and other 
pets. 

How do you massage a part ? 

By stroking, rubbing, kneading and tapping the part. 
Place a piece of stout paper which has been dressed with lard 
over the part to be massaged. This larded paper prevents 
the hair from becoming rubbed out. First stroke or rub 
gently the parts just beyond the inflamed area. After having 
thus emptied, so to speak, these tissues, massage the diseased 
parts in the direction of the emptied tissues, thus forcing the 



INFLAMMATION 67' 

exudate into the previously emptied tissues. In kneading 
the parts, rub the parts circularly with the pulps of the 
fingers, or, in the larger animals, with the closed fist. 
Massage by percussion is effected by tapping the surface 
over the diseased parts with the finger tips, the palm of the 
hand, or, in the larger animals, with a light wooden mallet. 

What class of drugs is employed in the treatment of chronic 
inflammation ? 

Those generally known as counter-irritants. 
Name the counter- irritants of special value generally employed. 

Such vesicants as cantharides and red iodide of mercury 
and the actual cautery. 

How do counier-irritants influence chronic inflammatory 
processes ? 
This question is by no means settled. Some claim that 
the irritant applied to the skin reflexly influences the blood 
vessels of the inflamed part, causing the blood to leave, so to 
speak, the deeper and affected parts and to accumulate in the 
artificially inflamed skin. The latest theory — and a rather 
improbable one — is that the chronic inflammation has been 
changed into an acute one. It is stated that the irritant 
causes the most deeply situated blood vessels of the chronic- 
ally inflamed area to dilate, followed by exudation of serum 
and emigration of the white blood cells. Out of these white 
blood cells certain ferments are formed which digest the 
albuminous constituents of the chronically inflamed part, 
with formation of an albumose liquefaction and subsequent 
absorption of the more solid inflammatory products. It 
seems to me that the action of vesicants and the actual 
cautery lies mainly in these facts : first, they cause decided 
pain, which induces the animal to rest the part exposed to the- 



68 PRINCIPLES OF VETERINARY SURGERY 

counter-irritant ; next, as the result of the swelling of the 
skin and subcutaneous tissues, a more or less continuous 
compression of the diseased tissues is obtained, while pro- 
longed compression even is exerted by the scar formation 
following the application of the actual cautery, which, as 
previously shown, has a favorable influence upon chronic 
inflammatory processes. Other factors no doubt play an 
important role, as yet to be demonstrated. 

When do you employ antiseptics to co7nbat inflammation 9 

Since a great many inflammations in animals are the 
direct result of a wound invasion by bacteria, antiseptic 
agents are required to inhibit their further development. 

What antiseptics are indicated to influence deeply located 
septic inflammation ? 

Those which penetrate the skin, as carbolic acid, iodo- 
form, camphor, etc. 

What operative measures may he empiloyed in the treatment 
of inflammation ? 

Venesection is to-day but little employed ; nevertheless, 
it is of value in an acute violent inflammation, especially 
indicated in that acute diffuse aseptic pododermatitis com- 
monly termed "founder." 

Scarification by punctures or incisions, while not often 
■employed, frequently give relief in intense congestions, with 
the integuments thick and brawny, as in rapidly spreading 
inflammations, deep seated suppuration. The incision or 
puncture must go through the skin and cellular tissue to be 
effective. Such wounds, of course, are given subsequently a 
thorough antiseptic treatment. In gangrenous inflammations 
the prompt removal of tissue shreds or sloughs, either by 



ABSCESS 6^ 

excision or amputation, is called for (gangrene of the tail, 
udder, ear, etc.) 



ABSCESS. 

What is an abscess ? 

It is a newly formed cavity circumscribed by embryonic 
tissue and containing pus. 

Describe the formation of an abscess. 

First, pus producing bacteria invade a part. The small 
vessels of this part are distended with blood or even leuco- 
cytes, the connective tissue fibres are swollen, and the lympli 
spaces are filled with exudate containing enormous numbers 
of leucocytes ; the fixed cells of the tissue also undej-go 
changes, become nucleated, resembling leucocytes. In the 
meantime the cocci have multiplied and massed together, and 
by their peptonizing action upon the fibrin of the exudation 
and intercellular substance the centre of the inflamed tissue 
liquefies and the abscess is ready. The abscess cavity is 
walled in by a zone of granulation tissue, this embryonic 
tissue actiug as a protective layer between the infected parts 
and the adjacent healthy tissue territory, the abscess becom- 
ing larger by liquefaction of the granulation tissue from 
within to without. When the inflammation finally reaches 
the surface, an elevation due to fluid pressure from within 
forms, which from tension and liquefaction becomes thinner 
and thinner, breaks, and the contents of the abscess cavity 
evacuate spontaneously. 

What classes of bacteria are mainly concerned in abscess 
formation in the horse ? 
Streptococci and staphylococci. The latest researches. 



70 PRINCIPLES OF VETERINARY SURGERY 

tend to show that the so-called botryomyces are no specific 

bacteria, but an aggregation of staphylococci. 

• 

What bacteria are mainhj responsible for the production of 
abscesses in cattle ? 
According to Lucet and Nocard, streptococcus pyogenes 
bovis, staphylococcus pyogenes bovis, bacillus pyogenes 
bovis, bacillus liquefaciens bovis, bacillus crassus pyogenes 
bovis. 

What forms of abscesses are recognized ? 

Acute, cold or chronic, circumscribed, diffused, gravita- 
tive, tympanitic, metastatic or pysemic, superficial, deep, 
intermuscular, subfacial, etc. 

What do you understand by an acute abscess 9 

One following an acute purulent inflammation. 

What do you understand by a cold abscess 9 

An abscess the result of a chronic purulent inflammation. 

What do you understand by a circumscribed, ivhat by a 
diffused abscess 9 
A circumscribed one is limited by a wall of granulation 
tissue ; a diffused one is usually more extensive and not 
limited by a wall of embryonic tissue. 

What is a gravitative abscess 9 

Abscesses point toward the point of least resistance ; 
therefore, depending on the nature of the tissues, the pus, 
trying to get out, wanders, appearing at some distant spot 
from its point of formation. 

What is a tympanitic abscess 9 

One containing gases of putrefaction. 



ABSCESS 71 

What is a metastatic abscess ? 

This is a secondary or symptomatic one. It is the 
embolic abscess of pyaemia. 

What is a superficial, deep, intermuscular, suhfacial abscess? 
It is termed superficial when occurring above the deep 
fascia ; deep when occurring below the deep fascia ; inter- 
muscular when occurring in a muscle ; subf acial when occur- 
ring below a fascia. 

Which animals exhibit abscesses most frequently ? 

Horse, dog, ox. 
In what region of the body are abscesses more generally found? 

Intermaxillary space, point of the shoulder, coronary 
region of the hoof, all parts exposed to harness pressure, as 
neck, back, etc.; fetlock, knee. 

From an anatomical ]}oint of vieiv, ivhere do abscesses more 
generally occur 9 
In the subcutis, below the fascia, in muscles, in the 
mammary gland and lymph glands. 

Describe the symptoms of a subcutaneous abscess. 

There is more or less local swelling, which is hardest at 
its periphery. This swelling shows increased heat and more 
or less fluctuation on palpation, as soon as the progressive 
softening of the tissues takes place and the pus reaches the 
surface. The time consumed for the "ripening" of the 
abscess and the intensity of the symptoms are variable, 
depending on the density of the tissues lying between the 
abscess cavity and the surface. The skin over the abscess 
cavity is tense and cannot be displaced, and has a peculiar 
fatty, glistening aspect. At the point where the abscess is 
shortly to break, the hair stands erect and drops out. In 



72 PRINCIPLES OP VETERINARY SURGERY 

non-pigmented parts the skin appears a lead color or bluish 

red. There may be fever. 

Describe the symptoms of a deep abscess. 

This is more difficult to diagnose, at least in its early 
formative stage. There appears soon local oedema, with a 
brawny feel, and other signs of suppuration, and, in case the 
leg is the seat of the deep abscess, great functional disturb- 
ance. Such symptoms may call for an explorative aspira- 
tion, puncture or incision made with proper precautions. 
How do you treat an abscess ? 

As long as the local swelling is hard, hasten the softening 
of the tissues by continuous hot antiseptic poultices. As 
soon as any fluctuation is apparent, at least in subcutaneous 
abscess, make a lengthy incision at the most dependent part ; 
irrigate the cavity with an antiseptic solution (bichloride of 
mercury 1:1000, formalin 1:1000, etc.) by means of a foun- 
tain syringe, several times daily; otherwise, institute the so- 
called open wound treatment. 

In deeply located abscess it would be faulty to wait for 
the abscess to point — that is, the detection of fluctuation by 
palpation — as the pus may gravitate, causing extensive 
necrosis and septic states. As soon as a deep abscess is sur- 
mised, make an incision through the skin, puncture the fascia 
carefully, and now, with the disinfected finger, by boring 
movements attempt to reach the abscess cavity. After 
thorough antiseptic irrigation of the deeply seated cavity and 
providing drainage, inject several ounces of iodoform and 
glycerine 1: 10, put in a drain, and after that treat same as a 
superficial abscess. 

Why are deep abscesses opened with the finger instead of 
ivith the thrust of a knife 9 

To avoid injuring important blood-vessels and nerves. 



ULCER 73 

Why do yoii, comhine iodoform ivith glycerine for the iinjection 
of deep and gravitating abscesses ? 

Glycerine, being heavy, enters every nook and corner of 
the diseased parts, drives out and brings to the surface float- 
ing products of septic inflammation. The glycerine subse- 
quently is absorbed, leaving behind a fine coating of iodo- 
form. This treatment has given me excellent results. 

Which are the characteristics of a chronic or cold abscess 9 

The course of the chronic abscess is slow ; there is little 
tendency to point ; symptoms in general are slight. There is 
little development of inflammatory heat ; therefore it is called 
also cold abscess. The wall of granulations limiting it is 
thick and more or less organized into a connective tissue 
capsule. 



ULCER. 



Define an idcer from a surgical point of vieiv. 

It is a granulating surface of the skin or mucous mem- 
brane with limited tendency to heal. 

What two main classes of idcers are recognized 9 

Primary or idiopathic, and secondary or symptomaticv 
ulcers. 

What two main classes of causes are concerned in the produce 
of ulcers ? 

Local and general causes. 
Enumerate the local causes of ulcers. 

Any agent keeping up an inflammatory process in a. 
wound, by continuously and locally irritating the wound, 
interferes with granulation and cicatrization, changing such 



74 PBINCIPLES OF VETERINAET SURGEEY 

a wound into a primary or iJiopatliic ulcer : as pieces of 
necrotic tissue or foreign bodies at the bottom of a wound, 
continuous licking of a wound as by dogs, tlie persistent 
shaking of an injured ear (dog), etc. 

Enumerate the constitutional causes of ulcers. 

Certain specific local or constitutional diseases are fol- 
lowed by secondary or symptomatic ulcers, as the ulcer of 
farcy, actinomycosis and tuberculosis, corneal ulcers follow- 
ing dog distemper, etc. 

What circumstances encourage ulcer formation in tissues ? 

The more any agent directly or indirectly interferes with 
the circulation or nutrition of a tissue, the greater the ten- 
dency of such a tissue toward ulceration. This interference 
with the nutrition or circulation may be brought about, for 
instance, by the action of pus cocci, these producing cell 
necrosis ; or the circulation may be interfered with by pres- 
sure from an exudate upon the part, prolonged pressure, as 
seen in decubitus (bedsores). Finally, corneal ulcer from 
diminished innervation, as in paralysis of the trificial nerve 
(neuro-paralytic ulcer). 

According to the quality of the granulations, what forms of 
ulcers are recognized ? 
Sluggish and painless, irritable and painful ulcers. 

According to the edges of the idcer, what forms are recog- 
nized ? 
The healthy or simple ulcer, with a smooth, moderately 
indurated edge ; and the callous, indolent or chronic ulcer, 
with a wall-like, irregular, indurated edge. 

Depending on the depth of the ulcer, tchat forms are known ? 
Superficial, deep, sinuous, tubular, fistulous. 



ULCER 75 

According to the quality of the surface granulations, what 
forms of ulcers are recognized f 

Fungous, or exuberant, phagedenic, gangrenous, diph- 
theritic. 

In describing an ulcer, ivhat main points are to he considered? 
Its granulations, edges, depth, surrounding skin, dis- 
charge, size, shape, seat. 

Describe a healthy idcer. 

Granulations small, cherry-red and regular ; discharges 
a limited quantity of laudable pus ; its edges slope and are 
"but little indurated ; its shape is regular, the surrounding 
skin flexible. 

Describe a fungous ulcer. 

Usually seen after injuries followed by undue contraction 
of the surrounding tissues, causing an obstruction of the 
venous circulation here. The granulations rise above the 
surrounding skin ; they may be large and flabby and bleed 
easily. 

Describe a phagedenic tdcer. 

It is due to infection by various micro-organisms ; its 
edges appear as if eaten out ; the surface of the ulcer is 
wanting in granulations, being covered with sloughing tissue. 

Outline the treatment of idcers. 

In some cases rest is sufiRcient ; for instance, dogs suffer- 
ing with ulceration of the tip of the ear are prevented from 
shaking the ears continuously by placing a hood over head 
and ears. In other instances, foreign bodies, bits of necrosed 
bone, cartilage, tendon, must be removed before healing can 
take place. Then, again, the granulations or the indurated 
edge may have to be removed by excision, curetting, cauter- 



76 TRINCIPLES OF VETERINARY SURGERY 

ization, wliile actinomycotic ulcers are treated with iodide of 
of potassium internally and parenchymatous injections with, 
tr. iodine. 

Do ulcers play an important role in veterinary surgery ? 

They do not. Most of them yield readily to treatment, 
excepting, of course, some of the specific ones, as those follow- 
ing the breaking down of malignant growths (carcinoma), 
farcy (its treatment is illegal). 

Name the more important and more frequently met luith ulcers 
of the domesticated animals. 

In the dog, ulceration of the tip of the ear, cornea (dis- 
temj)er), tip of the tail, stomatitis ulcerosa (tooth disease), 
carcinomatous ulcer. 

In the horse, ulcers about the lower extremities, de- 
cubitus (bedsores), carcinomatous ulcers, ulcers in the regions 
exposed to harness pressure. 

Give the treatment of the healthy, indolent, fungous anci 
phagedenic ulcer. 

Healthy ulcer : Allow rest to the affected part. In case 
disintegration is evident, hasten the separation of the dead 
tissues by warm antiseptic poultices. As soon as healthy- 
granulations are obtained after removal of the slough most 
any kind of dressing will heal a simple ulcer, as dusting the 
parts with tannoform, tannic acid and iodoform (3: 1), etc. 

Indolent ulcer : Healing can only occur by the produc- 
tion of granulations, to be brought about by creating hy- 
pera3mia. Soak the indurated edges for forty-eight hours by 
a warm alkaline antiseptic poultice. Then incise the edges at 
a right angle and dress antiseptically. These incisions favor 
contraction and granulations will sprout in them. After two 
days curette the whole ulcer until the parts bleed and sound 



FISTULA 77 

tissue is reached. Use warm antiseptic poultices for two 
more days. By this time all sloughs can be removed. Now 
treat the ulcer same as a simple or healthy one. 

Fungous ulcer : Remove the mushroom-like projections 
with the curette. Be sure to scrape its edges well. Follow 
"with astringent applications, as alum, tannic acid, tanhoform, 
sulphate of copper ; and wherever possible, hold them in 
place by a pressure bandage ; the dressings to be changed 
frequently. 

Phagedenic ulcer : Continuous warm antiseptic poultices 
to separate the sloughs. Should this be insufficient (shown 
"by the fact that the ulceration progresses rapidly), use the 
curette or knife or red hot iron to overcome the septic inva- 
sion ; after that, antiseptic stimulating applications are 
indicated. 



FISTULA. 

What is a fistula 9 

A tubular wound surface which does not heal and from 
"which either pus, some secretion or excretion is discharged. 

JVhat two main classes of fistula are recognized 9 

Purulent fistula and secretory and excretory fistulae. 

Naine the various varieties of fistula. 

The incomplete or blind fistula, the complete or com- 
municating fistula. 

What is a blind fistula ? 

One which leads to some necrosed tissue or foreign body, 
or empties into an abnormal cavity. 



78 PRINCIPLES OF VETERINARY SURGERY 

What is a complete fistula 9 

It represents an abnormal communication between two 
natural cavities or canals. 

What is a purulent fistula ? 

It represents the sequel of a chronic, destructive, deep, 
purulent inflammation, continued by necrosed tissues or 
specific micro-organisms, discharging its purulent exudate 
from a tubular tract. 

Name the more imijortant purulent fistulae . 

In the horse, quittor, funiculitis chronica (scirrhous 
cord), tooth fistula (lower premolar). In the dog, from upper 
maxilla, bony fistula, as from the sternum, ribs, pelvis ; 
inferior maxilla, coccygeal vertebrae. Fistula of the withers, 
neck and poll, and from suppurative phlebitis. 

What is a secretory and excretory fistula ? 

The first one is a pathological communication between a 
secretory organ and the body surface ; the second is an. 
abnormal canal between an excretory organ and the body- 
surface. 

Which secretory and excretory organs are more frequently 
Tnet with fistulous tracts ? 
In the cow, the udder or teat. In the horse, salivary 
glands, oesophagus, pharynx, stomach and intestines, urethra, 
between bladder and rectum or rectum and- vagina. 

Which congenital fistula is of practical importance ? 

The urinary fistula following wanting closure of the 
urachus in the newly born. 

Describe the symptoms common to purulent fistula ? 

Depending on the variety of fistula and locality involved. 



FISTULA 79 

the sym'ptoms differ. But in all cases there is a discharge, 
either specific in nature, as milk, saliva, urine, faeces, etc., or 
pus coming from the external fistulous opening termed the 
mouth of the fistula. This external opening, as a rule, is 
funnel-shaped, and either covei-ed with rather large granu- 
lations or, as the result of the reaction of the scar tissue 
formed by the fistula wound, the mouth is puckered. In 
probing the fistulous canal, a tract of variable length straight 
or tortuous is detected. The walls of the fistulous canal are 
either covered with sluggish granulations or are smooth and 
tough. As a rule, pain is absent unless a recent inflamma- 
tion followed by acute cellulitis has set in. 

Outline the treatment of purulent fistula . 

The essential feature in the treatment is the removal of 
foreign bodies or necrotic tissues. By doing so, the destruc- 
tive purulent process is stopped, healthy granulating wound 
surfaces replace the sluggish granulations or indurated walls 
of the fistulous canal, provided thorough drainage and 
reasonable antisepsis are established — imperative, whatever 
method of treatment is employed. 

What two methods may he em,ployed in the treatment offistidaf 
(1) By escharotics, (2) operative measures. 

Which is the more effective one of the two methods ? 

In the vast majority of cases, direct surgical measures, as 
the knife, curette, scissors, bone forceps, etc. 

What does the treatment by escharotics consist of 9 

It consists in the injection of caustics held in solution, in- 
jected with a view to slough out those agents which interfere 
with the process of healing, as corrosive sublimate, nitrate of 
silver, tr. iodine, villate solution, and the more lately intro- 



80 PRINCIPLES OF VETEBINARY SURGERY 

duced agent— and one certainly of great value— protargol ; 
also the actual cautery. 

What are the essential points to be observed in operating a 
fistula ? 
Do not simply split the fistulous canal ; it is insufficient ; 
but remove all chronically inflamed parts and the ulcerating 
bottom of the fistula, and provide drainage if necessary by 
counter openings. Reasonable antisepsis is necessary to <_ 
avoid infection of the operation wounds by the previous 
purulent focci, or an acute purulent infection — that is, acute 
cellulitis — is likely to follow. Never operate a fistula as long 
as an acute cellulitis involves its neighborhood — well exem- 
plified in quittor operations ; treat this cellulitis, and then 
operate. 

Describe the symptoms^ common to secretory and excretory 
fistida. 
There is a fistulous opening and a fistulous canal, which 
in the secretory fistula communicates with a gland, as, for 
instance, in the salivary fistula in the horse, the parotid ; 
while in the excretory fistula the fistulous tract leads to some 
excretory organ, as the stomach, bladder, rectum, etc. These 
fistulae, therefore, may discharge milk, saliva, urine, faeces, 
food, etc. 

Do secretory and excretory fistula yield readily to treatment ? 
They do not ; because the irritating nature and the con- 
tinuous pressure of the discharge persistently interferes with 
the process of healing. 

Outline the treatment of secretory and excretory fistida. 

The actual cautery and other escharotics are of little 
value. Usually the best procedure consists in changing the 



GANGRENE 81 

mouth of the fistula into a fresh wound and obliterating the 
opening by stitching it up. When this fails in secretory- 
fistula, removal or destruction of the gland becomes neces- 
sary. 



GANGRENE. 

Define gangrene. 

By gangrene, necrosis or mortification, is understood a 
local death of tissue. 

How is gangrene classified ? 

Into moist and dry gangrene, aseptic and septic gan- 
grene. 

What is dry gangrene ? 

A process of mummification. It represents a condition 
resulting from loss of water of the affected tissues. 

What is moist gangrene 9 

That form of gangrene where the necrosed tissues under- 
go softening or pulpification, as evaporation of the watery 
constituents of the tissue cannot easily take place. 

What is putrid gangrene ? 

Necrosis plus bacteria of decomposition. 

What is ichorous or phagedenic gangrene 9 
It is a putrid, rapidly spreading gangrene. 

What is emphysematous gangrene ? 

A gangrene due to a mixed infection with gas producing 
"bacteria. 



82 PRINCIPLES OF VETERINAEY SURGERY 

Which form of gangrene is more frequently seen in animals ? 
Dry gangrene, as from harness pressure and decubitus 
(bed-sores). 

Which part of the body is quite often attacked by moist 
gangrene ? 
The flexion surface of the lower pasterns in gangrenous 
dermatitis (aggravated scratches). 

How is the gangrenous process usually limited ? 

At the junction of the healthy and necrosed tissues a wall 
of granulations is thrown out by the healthy tissues, by 
means of which the slough or necrosed tissues are separated 
from the living parts. This line of granulations, establishing 
the separation of the dead from the living tissues, is termed 
the line of demarcation. 

Causes of Gangrene. 

Name the causes of gangrene. 

(1) Mechanical, (3) thermic, (3) chemical, (4) infectious, 
(5) a combination of the above. 

Describe the mechanical causes of gangrene. 

Most frequent one, consisting of mechanical interference 
with the circulation of the part, such as contusions, con- 
tinuous pressure, incarceration, thrombosis, embolism. 

How soon after interruption of the circulation do shin and 
muscles undergo gangrene ? 
In ten to twelve hours. 
Hoiu soon after interruption of the circulation do the intes- 
tines, brain or kidney undergo necrosis ? 

In one to two hours. 



GANGRENE 83 

Which parts resist gangrene considerably f 
Bones and cartilages. 

Describe the chemical causes of gangrene. 

To this class belong the escharotics. Caustic acids, as 
nitric acid, destroy the cells by coagulating the albumen and 
form a scurf, or kill the cells, as sulphuric acid, for instance, 
does by dehydration. Caustic alkalies change the tissue 
albumen into a smeary, soapy mass, while metallic caustics, 
as copper sulphate, chloride of zinc, corrosive sublimate, 
kills the tissue cells by precipitation of a metallic albuminate 
and the setting free of acids. Finally, snake poisons and 
certain toxines produce gangrene by chemical processes. 

Describe the thermic causes of gangrene. 

Here excessive heat (combustion) and cold are to be 
considered. 

Describe the infectious causes of gangrene. 

Certain streptococci and staphylococci, Bang's necrosis 
bacillus, the bacilus of malignant oedema, anthrax, acute 
glanders, etc., produce gangrene by their toxines, which pro- 
duce death of the affected tissues either chemically or by 
interfering with the circulation. Even certain fungi are also 
credited with such actions, as the ustilago carbo, tilletia 
caries, polydesmus exitosus. 

Describe the compound causation of gangrene. 

In all diseases where the circulatory apparatus of an 
animal is seriously taxed, as heart disease, general debility, 
fevers, cachexia, septicaemia, etc., extensive and serio\:s 
decubitus is seen to follow comparatively slight traumatisms^ 
explained by the limited vitality of the tissues due to the 
impaired nutrition of the body. 



84 PRINCIPLES OF VETERINARY SURGERY 

Describe the symptoms of dry gangrene. 

Since in this form the supply of arterial blood is gradu- 
ally diminislied, while the outflow of the venous blood is not 
interfered with, the tissues, aided by evaporation, gradually 
lose their water and mummify — that is, become hard and dry. 
Thus the gangrenous skin appears black or brownish, is 
hard and leathery, and feels cold and is painless, but little 
decomposition occurring in this form. 

What regions of the body are mainly exposed to dry gangrene? 

The neck and back, from harness pressure ; in animals 
which are in the recumbent position a great deal, the skin 
over the external angle of the ilium, and about the eyes ; in 
the dog, the tip of the tail ; in cattle, the claws. 

Describe the symptoms of moist gangrene. 

When the arterial blood supply or the return flow of 
venous blood is suddenly stopped, the following symptoms — 
that is, those of moist gangrene — are likely to be noticed : 
Depending on the part involved and the extent of the lesion, 
there is intense inflammation, more or less impaired function, 
lameness, etc. The affected tissues feel soapy and soft at 
first and change finally into a pulpy, smeary mass, while 
the natural color of the tissues is changed into either a yel- 
lowish, greyish, blackish, brownish, or greenish hue. Thus, 
for instance, the color of the lateral cartilage becomes dis- 
tinctly green. The .necrotic tissues are cold and insensitive, 
an ichorous, foamy discharge being present, accompanied 
by a decided stench, due to the presence of putrefactive 
bacteria, especially noticed in gangrenous emphysema. 

What constitutional effects may gangrene have ? 

It may be followed by septic and pysemic infection. 



GANGRENE 85 

What parts of the body are more frequently affected by moist 
gangrene 9 
The flexion surface of the fetlock in gangrenous der- 
matitis, the lateral cartilage in quittors, the coronary region, 
the sensitive laminae, the region of the neck, poll and back, 
the subcutis, fasciae, and muscles, as in fistulous states ; the 
interdental space in pullers, the udder of goats, cows, and 
sheep, etc. 

Outline the treatment of gangrene. 

Prevent it by removing as far as possible its causes, and 
promote the circulation of the parts. When a serious inflam- 
matory process threatens to terminate in gangrene, free 
incision of the parts may relieve the tension, as, for in- 
stance, in strangulated hernia, incision of the constricting 
ring. When gangrene is unavoidable, prevent infection and 
decomposition by thorough disinfection, and establish drain- 
age to get rid of the fluids of decomposition retained beneath 
the gangrenous cover, followed by frequently changed anti- 
septic dressings. If gangrene localizes itself, hasten separa- 
tion by warm antiseptic poultices, and after the part has 
cleaned off, treat same as an ulceration. Should the necrotic 
process continue to spread, amputate the affected part, pro- 
vided economic reasons permit such a course, as in gangrene 
of the udder, tail, tip of the tongue, ears, claws, penis (after 
paraphimosis). 

What constitutional treatment is indicated in gangrene 9 

In those cases of moist gangrene with tendency to spread 
and involving the deeper parts, absorption of ptomaines is 
likely to occur. These are forced into the lymphatic channels 
and connective tissue spaces along fasciae and tendon sheath 
(septic synovitis), or a thin walled vein may succumb to the 



86 PRINCIPLES OF VETERINARY SURGERY 

attack of the toxines, and pysemia follows. These parts 
cannot be drained ; they are beyond reach, and are to-day 
best combated by intravenous injection of Crede's soluble 
silver. 



TUMORS. 



Define a tumor. 

Generally speaking, it is a new growth, neoplasm, with 
tendency to persist, without physiological function, of non- 
inflammatory origin, the anatomical arrangement of its 
component elements differing from the tissues from which it 
springs. 
Does this definition cover all vieius on tumors 9 

It does not, as some of the authors also include new 
growths of inflammatory and infectious origin and cystic 
enlargements. 

Classify tumors from a clinical standpoint. 
(1) Benignant ; (2) malignant. 

Outline the characteristics of a benignant tumor. 

Its tissues usually are of the same nature as those from 
which it springs. It is mobile, usually encapsulated and cir- 
cumscribed ; it is painless and grows slowly because its blood 
supply is small ; it displaces but does not infiltrate the 
adjacent tissues. There is no enlargement of the regional 
lymph glands — that is, those between the tumor and the 
venous circulation. It does not affect distant metastasis, and 
when thoroughly removed does not recur. 

Outline the characteristics of a malignant tumor. 

Its tissues are radically different from its tissues of origin, 



TUMORS 87 

being of an embryonic type ; they are usually painful and 
develop rapidly, are seldom encapsulated and invade the 
most resistant surrounding tissues ; therefore they are im- 
movable. The surrounding skin is likely to adhere, the 
regional lymph glands become infected and enlarged. Little 
bits of the tumor from here reach the general circulation, 
followed by secondary or metastatic deposits in internal 
organs. When removed, they tend to recur and may lead to 
constitutional disturbances. 

Give a histological classification of tumors. 

Microscopical study of tumors permits of two main 
classes : 

1. Mesoblastic or connective tissue tumors. 

2. Epiblastic and hypoblastic or epithelial tumors. 

What are connective tissue tumors ? 

Those which are composed mainly of mesoblastic cells, 
exhibiting fibrous tissue (fibroma), osseous tissue (osteoma), 
cartilaginous tissue (chondroma), mucous tissue (myxoma), 
muscular tissue (myoma), etc. 

What are epithelial tumors ? 

Those which are composed mainly of epiblastic and hypo- 
blastic cells — that is, epithelial cells ; for instance, the car- 
cinoma. 

Mevieiv the etiology of tumors. 

1. They are due to the influence of bacteria or coccidia 
— a theory gaining in probability. 

2. Cohnheim's inclusion theory, viz.: During foetal de- 
velopment more embryonic cells were produced than necessary 
for foetal requirements. These embryonic cells which are in 



88 PRINCIPLES OF VETERINARY SURGERY 

excess and lying dormant, are stimulated hj some agent or 
other, leading to tlie growth of the tnmor. 

3. Hereditary influence. 

4. Irritation and injury. 

5. Predisposition (melano sarcoma of the gray horse). 

6. Age, sex, species, food. 

What observations tend to show that food and age are etiolO' 
gical factors in the development of tumors 9 
The statistics of various veterinary colleges show that in 
carnivora (dog) carcinoma are more frequently seen than in 
herbivora (horse, ox); also, that carcinoma have never or but 
rarely been noticed in dogs below the age of two years. 

What does the clinical examination of a tumor consist of f 

By inspection, learn its seat and size, whether circum- 
scribed or diffused, the nature of its cutaneous covering and 
that of the adjacent skin. By palpation, study its fixedness 
or mobility, consistency and state of the regional lymph 
glands, whether painless or not. Learn the age of the 
patient, and, if possible, the history of the development as to 
its rapidity. Finally, to settle doubts as to the nature of the 
neoplasm, a microscopical examination of a bit of the tumor 
may, although rarely, be called for. A general examination 
of the patient for constitutional disturbances should always 
be made. 

What reasonable deductions can be made from the data ob- 
tained by the clinical examination of a tumor ? 
1. The seat of a tumor or the nature of the tissues in 
which it originated suggests the following : Tumors in the 
testicles or mammary gland are likely to be carcinomata, 
botryomycoma in the testicular cord, fibromata, papillomata 
and carcinomata in the skin, in the subcutis lipomata and 



TUMORS 89 

fibromata, osteomata in the bones, neuromata in the nerve 
tissue, myomata in muscles, etc. 

2. Tbe age is of some importance, as young animals are 
rarely affected with cancer. Sarcomata and papillomata are 
more common in the young. 

3. In regard to the size and development, it is to be 
remembered that, generally speaking, malignant tumors 
grow quicker and are of larger size than innocent ones. Soft 
fibromata and sarcomata develop very rapidly, while in the 
horse sarcomata and botryomycomata attain a large size. Of 
some importance, also, is the fact whether the tumor is 
solitary or whether several tumors are present (multiple). 
To multiple new growths the papilloma and fibroma is in- 
clined ; while the sarcoma and carcinoma, when becoming 
generalized, give rise to multiple metastatic tumors. 

4. The surface of tumors permits of some deductions. 
Thus, the papilloma, fibroma, botryomycoma and carcinoma 
are nodular or bosselated (lobulated) in the fatty tumor, 
smooth in the sarcoma. 

5. Consistency. Sarcomata are the softest ones. The 
lipoma, soft fibroma, myxoma and cysts are also soft. Some 
types of fibromata and carcinomata are hard, while enchon- 
dromata and osteomata are of bony hardness. 

6. Relationship to the adjacent and overlying tissues. 
Benign tumors, as fibroma, lipoma, papilloma, are usually 
well defined and movable, no adhesions existing between the. 
tissues in which it originated and the adjacent skin. Sar- 
comata often invade the deeper tissues, while carcinomata 
are prone to ulceration. 

7. Regional lymph glands invariably exhibit metastatic 
swelling in malignant tumors. 

8. Animal species. Gray horses often show melano sar- 



90 PBINCIPLES OF VETERINAEY SURGERY 

comata ; otherwise, "botryomycosis is quite frequent in the 
horse ; dogs, again, are more likely to be affected with car- 
cinoma, while actinomycosis is common in the ox. 

Connective Tissue Tumors. 

FIBROUS TUMOR OR FIBROMA (PLURAL, FIBROMATA). 

What is a fibroma 9 

It is a benignant new-growth composed principally of 
fibrous tissue. 

What two forms of fibromata are recognized 9 

The hard (fibroma durum) and the soft (fibroma molle). 

How do these occur 9 

Either solitary or multiple. 

Describe the hard fibroma. 

It is elastic and hard, movable, and painless on section. 
It appears glistening, grayish-white ; firm ; blood-vessels 
scanty and small ; microscopically, it is made up of 
variously arranged fibrous tissue, a few yellow elastic fibres 
and very few connective tissue corpuscles. 

Describe the soft fibroma. 

It is more or less soft, depending on the amount of 
fibrous tissue present. It is composed of loose, succulent 
fibrous tissue. On section, it appears grayish-white, semi- 
transparent, juicy, glistening. Microscopically, it is com- 
posed of more or less loose connective tissue, numerous 
blood-vessels and connective tissue corpuscles. 

What secondary degenerative changes are fibromata subject to 9 
Mucoid change, calcification and ulceration. 



TUMOBS 91 

What type of fibroma is ijainful ? 

The fibroneuroma, seen to develop at the end of a cut 
nerve, especially in neurectomy wounds healing otherwise 
than by first intention. 

What is a polypus ? 

A pedunculated fibroma originating in the mucous 
membrane. 

What form of fibroma is most commonly seen in animals 9 

The hard one. The soft fibroma is only occasionally 
met with in the skin of the dog. 

What is a mycofibroma 9 

The mycofibroma or botryomycoma is a form of fibroma 
apparently due to the infection of the tissues by botryomyces, 
although V. A. Moore's (Cornell) researches, recently made, 
tend to show that it is not a specific infection, but most 
likely due to the invasion of the tissues by any one of several 
microorganisms, especially the micrococcus pyogenes aureus. 

What is a keloid 9 

A proliferation of fibrous tissue originating in a pre- 
existing scar, most commonly seen in the flexion surface of a 
joint, as the fetlock, for instance. 

What is a compound fibroma 9 

It is a tumor composed not only of fibrous tissue, but 
also of tissue peculiar to another tumor variety. Thus, when 
m.ade up of fibrous tissue and muscular tissue, it is termed a 
fibromyoma ; when mixed with nerve tissue, fibroneuroma ; 
when mixed with mucous tissue, fibromyxoma, etc. 

What are fibromata due to 9 

Nothing definite is known. Traumatic and inflammatory 



92 PRINCIPLES OF VETEEINARY SURGERY 

influences are believed in by some, while the main cause 
seems to lie in a fibromatous predisposition of the tissues or 
animal, the exact nature of which is unknown. 

Name the seats of predilectio7i of fibromata. 

1. Skin and subcutis. In the horse, they occur mainly 
about the sheath, head, shoulder and withers ; are usually 
solitary and sharply defined ; occasionally multiple in size ; 
they range usually from pea to apple size. Those in the 
subcutaneous tissue are mostly encapsulated. In the dog, 
fibrous tumors, occasionally pedunculated, are common about 
the extremities, eyes, ears, along the back and in the mam- 
mary gland. 

2. Mucous membranes. They are either pedunculated or 
have a broad basis. Other neoplasms exhibit the same 
symptoms : sarcoma, actinomycoma, lipoma. 

(a) Nasal cavity. Of special importance are the fibro- 
mata growing here, as they lead to stenosis and thus nasal 
dyspnoea, chronic nasal catarrh (with more or less stinking; 
discharge in case of ulceration). 

(b) Pharynx, larynx. Are quite rare in the horse ; in the 
ox, usually actinomycotic. 

(c) Vagina and uterus. More commonly met with in the 
cow, bitch and sow. 

(cZ) Milk ducts of the teat. Pedunculated fibromata are 
quite common in the cow. 

(e) In the udder. They are often seen in the bitch, are 
hard, nodular, circumscribed, of egg to fist size, and fre- 
quently are of a compound type, as adenofibroma, myxo- 
fibroma. 

(/) Testicles. Same as in the udder in both dogs and 
horses. 



TUMORS 93 

Outline the treatment of fibromata. 

Early extirpation with the knife, scissors, etc., wherever" 
possible, gives the best results. More difficulty is met with ia 
the removal of the pedunculated fibromata, especially thoso 
pretty well up the nasal cavitj'-, pharynx, teat, taxing the 
ingenuity of the surgeon. For their removal, the ecraseur, 
ligature, forceps, or even the hand itself are indicated. 
Fibromata with a very wide base are also destroyed by the 
actual cautery or by applying caustics at intervals. 

CONNECTIVE TISSUE NEW-GROWTHS DUE TO CHRONIC 
HYPERPLASTIC INFLAMMATIONS. 

What is a keloid ? 

It is a connective tissue proliferation originating in pre- 
existing scar tissue. 

Name the causes of keloid. 

Some authors believe in a specific infection, others in a 
fibromatous predisposition, while continuous irritation of the 
parts seems to me the main factor. 

Where are keloids found ? 

Commonly seen in the horse in the flexion surface of a 
joint, or about such regions exposed to continuous motion as 
the heels, coronet, hock, fetlock. 

Describe a keloid. 

They are often seen to follow barb wire cuts. Such a 
keloid is hairless, usually circumscribed, smooth, round, 
oval, elongated, firm and elastic. 

What practical importance is attached to them 9 

As a rule, they are of no consequence, representing 
simply an eyesore, but may, by reason of their position and 



94 PBINCIPLES OF VETERINARY SURGERY 

extent, interfere with the function of a part, giving rise to 
lameness and psendo stringhalt. 

How do you treat keloids. 

They are best left alone, excision executed lege artis often 
"being followed by a larger keloid than the one which was 
extirpated. 

What is elephantiasis 9 

A connective tissue hyperplasia of the subcutis and skin. 

In what animal is it most commonly seen 9 
Hind legs of the horse. 

What are the causes of elephantiasis ? 

Chronic stasis of the venous circulation, and more fre- 
quently a chronic indurating inflammation of the skin and 
subcutis, such as follows lymphangitis, purulent cellulitis 
and the more serious forms of dermatitis about the lower 
extremities. 

How do you treat elephantiasis ? 

No successful therapeutic agent is known. 

What is a tyloma 9 

It is a diffused callosity of the skin originating in the 
subcutis, representing a connective tissue hyperplasia. 

What are the causes of tylosis ? 

Continuous irritation, as from the collar, traces, har- 
ness, etc. 
Name the seats of predilection. 

In the horse, those parts irritated by the harness, as the 
neck, breast., etc. ; in the ox, the knee ; in the dog, the point 
of the elbow and ischial tuberosity. 



TUMOKS 95 

Hoiv do you treat a tyloma ? 
By excision. 

FATTY TUMOR, OR LIPOMA. 

What is a lipoma ? 

It is a benign, tumor composed of cells filled with fat 
imbedded in a connective tissue stroma. 

What forms of lipoma occur f 
The hard and the soft one. 

What is the difference between these ? 

The hard lipoma is composed of an excess of fibrous 
tissue, while in the soft variety adipose tissue j)reponderates. 

How do lipomata occur 9 

Solitary, occasionally mutiple, with a wide basis and 
pedunculated, as pure lipoma or mixed with other tissues 
(lipomyxoma, lipofibroma). 

Are lipomata common in animals ? 

They are not, but occur as often in a fat as in a lean 
animal. They seem to be met with most frequently in the 
dog, next in the horse, finally ox. As a rule, they are of 
limited clinical importance. 

Describe a lipoma. 

Depending on the amount of fatty tissue present, the 
consistency varies . As a rule, they are soft ; when tapped 
with the finger a peculiar tremor or pseudo fluctuation is felt. 
They are of variable size, circumscribed, round or oval ; as a 
rule painless, grow slowly and are mobile. 

What secondary degenerative changes are seen in lipomata 9 
Calcification and ulceration (due to traumatism). 



96 PKINCIPLES OF VETERINARY SURGERY 

What is the etiology of liiDomata f 

The same causes as enumerated under ''fibromata" are 
supposed to be active, although it seems that traumatic and 
infectious causes can hardly be concerned in their production. 

Name the seats of predilection of lipoTnata ? 

1. Subcutis. In the horse, about the thorax and ab- 
domen, crural region, anus, tail and sheath. In the dog, 
about the inside of the thigh, shoulder and pectoral region. 

2. Mucous membrane. In the horse they occupy the 
upper portion of the nasal cavity, originating in the mucous 
membrane of the septum or turbinated bones. They have 
also been observed in the larynx and on the epiglottis. Colic 
due to co-rectal obstruction from a submucous lipoma is on 
record. In the dog, li^Domata are occasionally met with on 
the membrana nictitans. So far, I have seen them only in 
Boston terriers. 

3. Peritoneum. Fatal colics have been observed when 
long pedunculated lipomata of subperitoneal origin wind 
around the intestines in both cattle and horses. 

4. Mammary gland. Occasionally seen in the fat bitch. 

Hoiv do you treat lipomata ? 

The circumscribed variety is best removed by incision 
with the knife. The pedunculated form may be ligated. 
The application of caustics and the actual cautery are not 
advised, as they produce nasty, badly-healing wounds. 

MUCOUS TUMOR — MYXOMA. 

What is a myxoma ? 

A benign tumor composed of mucous tissue. 

Describe mucous tissue. 

This tissue type is met with in the vitreous humor of the 



TUMOES 97 

eye, and is also represented by the so-called Wliartonian 
jelly of the umbilical cord. Microscopically, it is composed 
of stellate connective tissue cells, the branching processes of 
which form a network in which the gelatinous basis sub- 
stance is lodged. 

Do all authors look upon the myxoma as an independe7it type 
of tumor 9 
They do not. Some claim that the myxoma is simply an 
oedematous fibroma or lipoma ; in other words, a myxofi- 
broma or myxolipoma. Others state that they are simply 
connective tissue tumors which have undergone mucoid 
change. 

How does the myxoma occur ? 

Usually solitary and pedunculated. 

Describe the myxoma. 

It is quite rare ; as a rule, small, soft, elastic, vibratory 
and pedunculated ; grows slowly. On section, it is yellowish- 
grey, and a glairy mucin containing fluid exudes. 

How do you differentiate these from soft, fibrous, or fatty 
tumors, etc. 

By testing contents with hypodermic needle. 
To what secondary changes are these tumors liable f 

Inflammation, ulceration, fatty degeneration. 
What are the causes of myxomata 9 

Not known. 
Name the seat of predilection of the myxoma. 

About the same as fibromata, as subcutis, submucosa, etc. ; 
therefore, in the horse it is most commonly met with in the 
upper portion of the nasal cavity, here called nasal polypus, 



98 PRINCIPLES OF VETERINARY SURGERY 

having been found here also in the ox. Occasionally they are 
seen in the bovine bladder and uterus. 

Outline the treatment of myxomata. 

Early extirpation with the knife, scissors, ecraseur ; when 
necessary, trephining the nasal cavity to reach it. 

Cartilaginous Tumor — Chondroma. 

What is a chondroma ? 

Chondroma, or enchondroma, is a tumor composed prin- 
cipally of hyaline or fibrocartilage. 

How do they occur ? 

Usually as a mixed tumor ; quite often solitary, while in 
the dog multiple. 

Describe a chondroma. 

They grow slowly, are firm, elastic, painless, and of vari- 
able size ; are smooth or nodular. 

To what secondary changes are they liable 9 

Ossification, calcification, cystic degeneration. 
Name the seats of predilection. 

While a comparatively rare tumor, it is most frequently 
seen in the mammary gland of the bitch ; further, in the tes- 
ticle and on the vocal cord of the horse, costal cartilages of 
the horse and ox, on the jaws of dogs and horses, and in the 
subcutis of cattle. 
Outline the treatment of chondromata. 

Extirpation by knife. On the whole, they can be safely 
left alone, as they are distinctly benign unless impairing 
function by reason of their size or position. (This also refers 
to the mammary enchondroma of the bitch.) 



TUMORS 99 

Osseous Tumor — Osteoma. 

What is a7i osteoma ? 

An innocent new-growth composed either of compact or 
cancellous bone. 

How do they occur 9 

Solitary or multiple, with wide basis or pedunculated, 
either as pure or mixed tumors. 

Describe an osteoma. 

It grows slowly, is hard or densely hard, painless, more 
or less circumscribed, connected with a bone or cartilage. 
According to their consistency, they are known as ivory oste- 
oma (osteoma eburneum); when capped with cartilage, as 
exostosis cartilaginea ; when overlaid by a bursa, exostosis 
bursata. 

What do you understand by an exostosis ? 

A bony new-growth, the result of an inflammation. 
Name the seats of predilection. 

In the horse, about the lower third of the lower maxilla 
and internal face of the metacarpus, in the cavities of the 
head of the horse and ox, and in the mammary gland of the 
bitch. 

What is a dental osteoma or odontoma ? 

It is a bony new-growth originating in the developing 
tooth or alveolar periosteum. 

Muscular Tumor — Myoma. 

What is a myoma ? 

An innocent tumor composed of muscle fibres. 

I. OF C. 



100 PEINCIPLES OF VETERINARY SURGERY 

Wliat tivo varieties of myomafa are recognized 9 

1. Composed of striated muscle elements — rhabdomyoma, 
•which is very rare. 

2. Composed of non-striated m.uscle cells — leiomyoma. 

Name the seats of predilection. 

As a rule, the internal organs, bladder, stomach, uterus, 
intestines, testicles, ovaries, kidneys. 

Are they of practical interest ? 

Hardly, as they are exceedingly difificult to diagnose, and 
beyond reach as to treatment. 

What is the treatment of myomata ? 

The internal use of ergot may be tried. 

Nerve Tumors — Neuromata. 

What is a neuroma ? 

A new-growth composed of nerve fibres. 

What two forms of neuromata are recognized ? 
(1) True neuroma ; (2) false neuroma. 

What is a true neuroma ? 

It is a neoplasm made up of either myelinic or amyelinic 
nerve fibres, rarely if ever seen in animals. 

What are myelinic and luhat are amyelinic nerve fibres f 

The former have myeline within their sheath ; the latter 
have not. 

What is a false neuroma f 

It is a mixed tumor, being either a neurofibroma or myxo- 
fibroma developing from the nerve sheath. 



TUMORS 101 

Describe a false neuroma. 

It is a pea to thumb size, somewliat movable, bard, pain- 
ful new-growth of comparatively slow development, usually 
met with at the proximal end of a divided nerve. 

What are the causes of false neuromata ? 

They follow almost invariably neurectomies, and are due 
to stretching the nerve before cutting it, or severing the 
nerve below the upper wound commissure, thus allowing its 
proximal end to project out of the upper wound commissure. 
This exposes the connective tissue of the nerve sheath to irri- 
tating influences, invariably seen in wounds healing by second 
intention — that is, those with pus formation, as a result of 
which connective tissue proliferation, expressed by a bulbous 
thickening of the proximal nerve end, takes place. 

Name the seats of predilection. 

After neurectomies they are found at the proximal end of 
the median, plantar and tibial nerves. 

Outline the treatment of neurofibromata. 

Dissect it loose from the surrounding tissue and am- 
putate. 

Are they likely to recur 9 

The amputated tumor never recurs, but since a new neu- 
rectomy has to be performed to amputate the new-growth, a 
new fibroneuroma may start from the recent proximal nerve 
stump. 

Are neurofibromata of practical interest ? 

Decidedly so, as they cause lameness. They are very 
often met with, and will continue to be met with frequently, 
as long as the surgeon does not operate lege artis — that is, he 
must not stretch the nerve, dig around and mutilate the tis- 



102 PRINCIPLES OF VETEEINAKY SURGERY 

sues, and operate aseptically, which is practicable by reason 
of the ease with which it can and should be executed in all 
neurectomies but deep peroneal. 

Vascular Tumor — Angeioma. 

What are angeiomata 9 

Tumors composed of blood vessels. 

What forms of angeiomata are recognized ? 

(1) The simple angeioma (angeioma simplex); it is com- 
posed of anastomosing vessels, enlarged and tortuous capil- 
laries ; (2) the cavernous angeioma (angeioma cavernosum), 
which consists of thin-walled spaces or even vessels contain- 
ing blood ; their construction resembles the corpus caver- 
nosum of the penis, the blood flows into the space from arter- 
ies and is received by veins ; the lymphangeioma, composed 
of dilated lymph vessels. 

Describe the angeioma. 

They resemble a cyst, are of bluish or purple color, have 
a more or less wide base, are compressible and may pulsate. 

Which forms are seen in animals 9 

In the erectile tissues of the nasal mucous membrane of 
the horse the simple, and especially the cavernous, angeioma, 
giving rise to dyspnoea, is met with. They have also been 
observed in the conjunctiva, lips and gums. In the mammary 
gland of a cat a lymphangeioma has been reported. On the 
whole, they are not often observed. 

To what secondary changes are angeiomata liable ? 

Ulceration leading to more or less hemorrhage, purulent 
nasal discharge, creating suspicion of glanders. 



TUMORS 103 

Holu do you treat an angeioma f 

Their hidden position renders diagnosis and treatment 
difficult. When they can be reached, they may be punctured, 
fired, or liquid iron preparations injected into them, taking 
the precaution to compress the vessels which carry the blood 
out of the tumor long enough to insure coagulation, as other- 
wise an embolus might be swept away and lead to compli- 
cations. 

Lymphatic Gland Tumor — Lymphom.a. 

What is a lymphoma ? 

A tumor of lymphatic gland structure. 

Where do they develop ? 

They originate in pre-existing adenoid tissue. 
What forms oflymphomata are recognized ? 

1. The metastatic swelling — that is, an inflammatory 
hyperplasia of the lymph glands as a result of chronic dis- 
ease of neighboring parts, such as tuberculosis, glanders, 
actinomycosis, equine distemper, catarrhal states. 

2. Malignant lymphoma. 

Describe the malignant lymphoma. 

The lymph gland or glands undergo hyperplasia of their 
normal elements. It is peculiar to the disease known as 
pseudo-leukemia, or Hodgkin's disease. It is observed in 
horses, cattle and dogs. The tumors are multiple, painless; 
the enlargements variable, occasionally of great size ; groups 
of lymph glands or those of the whole body may be hyper- 
plastic ; they may be hard, firm or sof tish, have the shape of 
the gland, only materially enlarged. The lymph glands 
more frequently observable are the intermaxillary, cervical, 
inguinal, those below the knee, etc. 



104 PRINCIPLES OF VETERINARY SURGERY 

Outline the treatment of lympliomata. 

Solitary lympliomata — that is, the swelling of regionary 
lymph glands — when due to specific infections, are not treated 
(glanders, tuberculosis, etc.); those due to simple chronic 
nasal catarrh take care of themselves as soon as the catarrhal 
state is relieved ; those of equine distemper undergo abscess 
formation and are treated as such. 

The treatment of multiple lymphomata of Hodgkin's dis- 
ease are not treated surgically, but iodide of potassium or 
arsenic, with proper dietetic regime, may be tried. 

Sarcoma. 

What is a sarcoma 9 

A malignant tumor composed of immature connective 
tissue — that is, embryonic tissue. 

Describe the histological structure of this tumor. 

The number of cells are vastly in excess of the basis sub- 
stance. The cells are either round, spindle, giant cells or 
endothelial cells ; they have from one to more nuclei ; there 
is no distinct cell wall, and the stroma consists of an irregu- 
larly arranged intercellular cement ; in other words, there are 
no alveoli formed, as in carcinomata. The blood vessels, 
which are very thin walled or sometimes only represented by 
spaces, ramify among the cells, not running in the stroma 
as in carcinomata, because of the absence of any regular 
stroma. 
Hoiv do sarcomata groiu 9 

Spasmodically ; now fast, now slow. 
To 'what degenerative changes are they subject ? 

Cystic formation, ulceration, hemorrhage, necrosis. 



TUMOKS 105 

Do they alivays occur as pure sarcomata ? 

They do not, but also appear as mixed tumors, as fibre 
sarcoma, osteo sarcoma, etc. 

What varieties of sarcomata are recognized ? 

1. The round-celled sarcoma. This is usually soft, vas- 
cular, fast growing, attains often large size, and gives rise to 
metastatic deposits in other organs. Its round cells vary in 
size and are imbedded in a homogeneous intercellular basis 
substance. On section they exhibit the vascularity and con- 
sistency of brain matter. 

Name the subvarieties of round-celled sarcomata. 

(a) The lympho sarcoma. Grows in lymphatic glands. 

(b) The alveolar sarcoma. So called as each cell is 
enclosed in a separate space or alveolus by the basis 
substance. 

(c) Melanotic sarcoma. Here the cells and the inter- 
cellular basis substance is pigmented, due, according 
to the latest researches, to specific embryonic cells 
capable of producing pigment. 

2. Spindle-celled sarcoma. It is composed of oat-shaped 
cells or of very elongated bodies. A subvariety is the mela- 
notic sarcoma. 

3. Giant-celled sarcoma. It is made up of round and 
spindle cells and large bone, marrow-like cells with many 
nuclei. Their consistency is from that of jelly to that of 
muscle. 

4. Mixed-celled sarcoma. Composed of an admixture 
of round, spindle, star-shaped cells. 

5. Endothelioma or angiosarcoma springs from the endo- 
thelial cells of lymph and blood vessels, which become en- 
larged and cylindrical. They are very malignant and subject 
to hemorrhage. 



106 PMNCIPLES OF VETERINARY SURGERY 

6. Melanotic sarcoma. Mainly seen in gray horses, but 
also in sorrels, blacks and bays. It is either a round or 
spindle celled sarcoma, developing quite rapidly, and subject 
to metastasis. As previously stated, it is pigmented, this 
pigmentation depending upon the so-called melanocytes. 

Which seats of predilection are of practical importance 9 

1. Bones. In horses and cattle, in the nasal cavity and 
sinuses, leading to nasal dyspnoea and chronic catarrh. In 
the dog, they are usually seen on the upper jaw, the tumor 
having received the name of Epulis ; it is located on the 
gums, loosening and displacing the teeth, appearing as a 
firm or hard, painless, irregular-surfaced proliferation. Soli- 
tary and multiple osteosarcomata are seen also in the horse, 
cattle, swine and dog, in the scapula and humerus, femur and 
tibia, temporal bones, cervical and dorsal vertebrae, and 
according to the part involved may give rise to lameness or 
even paralysis. 

2. Lymph glands. In the horse, they are met witli as 
soft, cystic or fluctuating neoplasm in the intermaxillary 
space at the point of the shoulder, on either side of the 
sheath or in the glands of the pubic region. In the dog, the 
pubic and neck region at times exhibit them. 

3. Skin. In the skin and subcutis of the horse they are 
seen in the scapula and cervical region, often forming here 
large tumors, which may undergo gangrenous changes, and 
by their pressure upon the trachea may interfere with respira- 
tion. Other places involved are the sheath, lips, anus. In 
dogs, they are seen about the extremities ; while in bovines, 
about the vulva and vagina. 

4. Eye. They occasionally develop in the orbital cavity 
of the horse, cat and dog, producing strabismus, etc. In 
such cases they may destroy the bones and enter the frontal 



TUMORS 107 

maxillary sinuses, and even cranial cavity. In tlie eye proper 
they are found upon the choroid and retina. 

5. Testicles. The gland continuously enlarges until even- 
tually it softens. The same may be said of sarcomata devel- 
oping in the thyroid, mammary and parotid glands, although 
in these the growth may also be circumscribed. 

6. Sub-pleural or peritoneal sarcomata are quite common 
in the dog, horse and ox, but being beyond reach are of no 
surgical interest. 

7. Melanotic sarcoma. Most commonly met with in the 
gray horse, but also occur in sheep, ass, dog and ox. They 
are either solitary, multiple or generalized. They may de- 
develop almost anywhere, even in bones and muscles, but 
usually are seen about the anus, vagina and vulva, penis, 
sheath or tail, about the cheeks, eyes, lips. The metastatic 
deposits are more frequently seen in the lungs, lymph glands, 
heart, liver, etc. 

What are the prognostic features of melanotic sarcomata ? 

Even when generalized they do not lead to constitutional 
disturbances except by reason of their position, as, for 
instance, one interfering with defecation would sooner or 
later lead to a fatal colic, etc. 
Describe the treatment of sarcomata. 

Early extirpation with the knife is essential. After 
m.etastatic changes have once established themselves no 
treatment is of any use. Isolated and hard fibro-melano 
sarcomata may be successfully removed, as this form of 
melano sarcoma is of a rather benign type. 

The treatment of sarcomata with caustic, as arsenic, etc., 
is nonsensical. All cancers supposed to have been cured with 
such and similar paste, usually received by some empiric 
under the promise of secrecy, were of a benign tumor type. 



108 PRINCIPLES OF VETERINARY SURGERY 

Epithelial Neoformations — Epiblastic and 
Hypoblastic Tumors. 

CARCINOMA. 

What is a carcinoma 9 

A malignant tumor growing from epithelial surfaces^ 
having its epithelial cells clustered in nests (alveoli) bounded 
by fibrous tissue. 

Are carcinomafa found in non-epithelial tissue 9 

They are ; but in these cases they are secondary (meta- 
static). 
What do you understand by cancerous cachexia 9 

This, also termed carcinomatosis, represents a nutritive 
disturbance, a generalized chronic sepsis, a sort of auto- 
intoxication, most likely due to the absorption and diffusion 
of secondary products originating from the carcinoma. 

What forms of carcinomata are recognized 9 

1. The squamous-celled epithelioma. 

2. The cylindrical or columnar celled epithelioma. 

3. The acinous or spheroidal celled carcinoma. 
Subdivided into : 

(a) Hard or scirrhous cancer. 

(b) Soft or encephaloid cancer. 

Describe the squamous-celled epithelioma. 

It springs from the skin or mucous membranes ; in other 
words, from free epithelium-clad surfaces, especially at the 
junction of cutaneous and mucous surfaces. It is composed of 
flattened cells, surrounded by a fibrous stroma ; such a nest of 
cells is called epidermic pearls or cell nests. It begins usually 
as a wart -like growth or fissure, ulcerating early. On section^ 



TUMORS 109 

tliey are not very juicy, white, rather dense and homogenous ; 
the consistency is greater than the surrounding tissue ; the 
regional lymph glands are invariably involved, especially 
seen in the epitheliomata originating from the skin or mucous 
membranes of the head (submaxillary lymph glands). 

Name the seats of predilection. 

Any mucous or cutaneous surface, as the skin, mucous 
membranes of the vagina, bladder, mouth, pharynx, penis, etc. 

Describe the cylindrical-celled epithelioma. 

This springs from the cylindrical surface epithelium of 
mucous membranes, and shows no ' ' cell nests. *' The walls of 
the diseased organs exhibit infiltrating indurated masses, 
which ulcerate early. It is composed of masses of ej^ithelial 
cells, and a fibrous tissue stroma in which columnar cell lined 
tubular glands rest. 

Name the seats of predilection. 

The mucous membranes of the intestines, uterus and 
stomach. 

Describe the acinous-celled carcinoma. 

Depending on the amount of fibrous tissue present, it may 
"be soft or hard. In the former, the so-called encephaloid 
cancer, the cellular element predominates; while in the latter, 
or scirrhous, the fibrous framework predominates. This also 
explains the rapidity of their growth, the soft one developing 
much more rapidly and ulcerating earlier than the scirrhous 
type. 

The acinous carcinoma originates only in the glandular 
epithelium. The hard cancer, as its name indicates, is a hard, 
tuberous growth at first movable with the gland ; later, by 
infiltration, the surrounding tissue becomes immovable, as it 



110 PKINCIPLES OF VETERINAEY SURGERY 

adheres to the skin and adjacent tissues. In due time it 
usually implicates the regional lymph glands, and the finale 
is ulceration of the superjacent parts. Such a carcinomatous 
ulcer appears, with hard, everted edges, irregular outline and 
depth, rarely showing granulations, and is usually covered 
with sloughs. On section the knife creaks as it passes 
through, the cut surface having a cupped appearance. It is 
firm and white, very succulent, yielding the so-called cancer 
juice, a milky fluid mainly composed of epithelial cells. 

The soft variety on section appears somewhat like brain 
substance, both in consistency and looks, for which reason it 
is also called encephaloid. It is soft, and grows much more 
rapidly than the scirrhous form. They may form bosselated 
masses or globular bodies, or are composed of a number of 
rounded masses. They ulcerate readily, at times exhibiting a 
nasty, fungating, easily bleeding, mushroom-like mass termed 
" fungus hsema todes.^' 

What secondary clumges are carcinomata liable to 9 

Ulceration, cystic degeneration, fatty and myxomatous 

changes. 

Name the seats of predilection. 

Testicles, mammary glands, parotis, thyroid, prostate 

gland, kidneys, liver, sudorific and sebaceous glands, etc. 

Hoiu is the behavior of carcinomata explained ? 

The blood vessels are normal and ramify in the stroma 
(in the sarcoma they are thin-walled and ramify among the 
cells). The individual cells of the carcinoma are always of 
the type of the parent cell ; for instance, those originating 
from the skin are squamous, those from glands are spheroidal, 
etc. Those carcinomata having little fibrous tissue grow 
fastest, as their blood supply is rich and evenly distributed. 



TDMOES 111 

not enough fibrous tissue being present to obliterate the 
vascular supply by active contraction of this fibrous stroma. 
In the slowly developing tumors the blood supply is scanty 
from the beginning, on being confined mainly to the periphery 
of the growth, having been destroyed in the central portion 
by the rapidly forming and contracting fibrous tissue. These 
central portions, therefore, undergo fatty degeneration and 
break down, that is, ulcerate, provided they are located near 
a free surface, as the skin. Since the stroma in some forms 
of carcinomata is very limited, the blood vessels of such a 
tumor have but little support ; thus hemorrhage into the 
substance of the tumor or bleeding from the ulcerated surface 
is explained. The metastatic disposition of the cancerous 
tumors is explained by the fact that the cells proliferate in 
the connective tissue, lymphatic spaces reaching from here 
the nearest lymph gland (regional lymph gland). From here 
another lymph gland is attacked, until eventually the viscera 
are reached. Whenever this occurs the general health suffers, 
and the state carcinosis or cancerous cachexia sets in, leading 
to death from impaired nutrition, by the purulent and 
hemorrhagic discharges, involvement of important viscera, 
most likely also helped by the absorption and diffusion of 
septic products arising from the ulcerating carcinoma. 

Give the etiology of carcinomata. 

No positive data exist, and a great many theories applied 
to human carcinosis are of no value whatsoever in our 
animals. 

1. Age. Since a great many animals for economic 
reasons are not permitted to reach an advanced age, little can 
be said as to influence of age in carcinomata. In the ox, 
therefore, very few cases, indeed, are on record. In the dog, 
it appears that they are unknown in those younger than two 



112 PRINCIPLES OF VETERINARY SURGERY 

years old, the vast majority having been met with in the dog 
five years and okler. In the horse they are also more 
frequently seen in the older animal. 

2. Food and hereditary tendency are claimed by some to 
be of etiological moment, it occurring especially in carnivora 
and rarely in herbivora. These two j)oints seem of very 
doubtful value. 

3. Irritations. I do not believe that irritations either 
. traumatic or chemic are the direct causes ; they simply pre- 
dispose. Experiments made upon animals by exposing them 
to continuous irritation have failed to produce carcinomata. 
Furthermore, carcinomata are found in parts which are not 
exposed to irritations, as the thyroid gland, mucous mem- 
branes of the head, etc. Cancer of the lip and tongue, places 
certainly exposed to decided irritation, for instance, in the 
horse, according to this theory ought to be frequent, but, on 
the contrary, they are very rare indeed. 

4. Parasitic infection. All the various bacteria and 
coccidia so far named as etiological factors, on further 
experimentation have proved to be saprophytes, and in the 
case of protozooa and coccidia proved to be no coccidia at all, 
but degenerative changes of the epithelial cell, their nuclei 
or nucleoli. In defense of this parasitic theory it is stated that 
cancer has been produced by artificial inoculation. But since 
most of tjie inoculation experiments turned out negative, this 
theory also needs further support. 

5. Cohnheim's inclusion theory also fails to explain the 
development of most carcinomata, and is only applicable in 
those cases so rarely met with, primary carcinoma of bone or 
lymph glands. 

In luhich animals are carcinomata Tnainly seen 9 
Horse, dog and cat. 



TUMORS 113 

What anatomical structures most commonly exhibit carcinoma? 

In the horse : Mammary gland, kidneys, testicles, facial 
bones, ovaries, stomach, penis, retropharyngeal glands, 
spermatic cord, epiglottis. 

In the dog : Skin, mammary gland, anus, prostate, 
testicles, vagina, penis, thyroid. In this animal cancerous 
cachexia is not an infrequent occurrence. 

Hoiv rapidly do carcinomata develop ? 

The proliferation may persist for months or years ; the 
primary hard tumor develops slowly. 

How does the frequency of sarcomata compare with that of 
carcinomata 9 
Carcinomata are not as often seen as sarcomata. 

Generally speaking, lohich parts exhibit carcinomata oftenest ? 
Sexual organs, mammary gland and thyroid. 

Describe the carcinoma of the skin. 

Most frequently seen in the dog on the ears, eyelids, 
prepuce, scrotum ; on the tail and back, anus and lower 
extremities. In the horse : the tail, prepuce, penis. 

The skin cancer may be circumscribed or diffused, 
infiltrates the surrounding tissues and leads to ulceration of 
the skin. It is usually hard, of irregular surface, has 
secondary nodules in the surrounding parts and secondary 
swelling of the regional lymph glands. Those about the 
penis are usually of large size and of ragged appearance. 

Describe the carcinomata of the mucous membrane. 

In the horse those in the superior maxillary sinus are firm, 
lobulated, vascular new-growths, containing a milky fluid, 
with a tendency to break into the frontal sinus or into the 



114 PRINCIPLES OF VETERINAEY SURGERY 

buccal cavity, accompanied witli early swelling of the regional 
submaxillary glands. The same refers to those of the pharynx 
of the dog. They are also seen on the membrana nictitans of 
the horse and may fill the whole of the orbital cavity, 
eventually destroying the adjoining bones entering the 
sinuses. In the horse, dog and ox they are further seen upon 
the mucous membranes of the vagina, uterus and bladder. 
The only case of lingual carcinoma was observed in England 
on a twelve year old cat. 

Describe the acinous carcinoma. 

The mammary gland of the dog seems most frequently 
involved. They vary in consistency and size, and are mostly 
painless ; the surrounding parts exhibit cancerous nodules ; 
the skin may or may not be ulcerated ; the regional lymph 
glands are usually infiltrated. They may become very hard 
by calcification or ossification, but may also show fluctuation 
on account of cyst formations. Those of the testicles lead to 
a decided enlargement of the glands, thickening of the sper- 
matic cord, and swelling of the inguinal glands. 

Those of the thyroid gland are of interest. In the horse 
and dog they develop like a stroma, causing rapid emaciation 
and marasmus. They may attain a large size in the dog, 
exceeding in the horse the size of a man's head. 

The prostatic carcinoma in the dog, getting the size of a 
man's fist, is diagnosed by rectal palpation, it leading to con- 
stipation by obstructing the canal. Those in the dog about 
the anus are of mushroom or warty-like appearance, and quite 
common. 

The carcinomata involving internal organs are of little 
surgical interest, at least from a practical standpoint. Usually 
multiple and subject to metastasis, involving the pleura, 
peritoneum, mediastinal glands, etc. 



TUMORS 115 

How do you treat carcinomata 9 

Early extirpation with tlie knife. The best results give 
those about the anus, membrana nictitans, skin, penis, mam- 
mary gland and testicles. The operative treatment of those 
of the sinnses of the head is very unsatisfactory ; this refers 
also to the removal of the thyroid gland. 

In pet dogs with inoperable carcinomata, it would not be 
out of place to inform the owner of the possibility of an 
infection. The operating surgeon should take care of him- 
self, as it is a fact that a number of veterinarians belonging 
to our times have succumbed to carcinomatosis. 

Papilloma — Warty or Villous Tumors. 

What is papillortia ? 

An innocent mixed tumor, representing a proliferation of 
the papillary body and hyperplasia of the epithelium of the 
skin and mucous membranes. 

Do all authors agree luith this definition ? 

Almost all modern investigators do, although some still 
state that the papilloma should be counted among the fibro- 
mata, representing a connective tissue proliferation of the 
impillary body. 

What forms of papiUomata are recognized ? 

1. TLe wart (verruca). 

2. Condyloma. 

Describe the papilloma. 

Their structure shows one or more central blood vessels 
surrounded by a varying amount of connective tissue, the 
whole being covered by epithelial cells like those of the skin or 
mucous membranes. The warts may be solitary or multiple. 



116 PRINCIPLES OF VETERINARY SURGERY 

usually circumscribed, more rarely represented by cauli- 
flower-like masses. They are hard, covered by horny epi- 
thelium, the vascular supply as a rule being small. Of the 
other type, the condyloma, but little is known in animals. It 
is a soft papilloma, quite vascular, moist, and not covered 
with horny epithelium, showing a granular, cauliflower-like 
surface. 

Give the etiology of the jpapilloTnata ? 

Continuous irritation seems to be actively concerned. 
Thus papilloma about the vulva seems to follow chronic dis- 
charges, the verrucous form of dermatitis following the 
infectious and subsequent chronic inflammation of the skin in 
the flexion surface of the fetlock. 

Horses and cattle grazing on stubble pasture get papil- 
lomata about the lips. Another factor is heredity ; puppies, 
colts and calves are born with them. In some instances it 
almost appears as though some infectious agent was concerned 
in the etiology of papillomata. I have seen every calf belong- 
ing to the South Carolina Experiment station within one 
month become covered with warts of variable size, the animals 
distinctly running down while affected with papillomatosis. 
Inoculation experiments proved negative ; also histological 
a,nd bacteriological studies failed to throw any light upon 
the subject. 

What animals show papillomata most frequently ? 

The horse, cattle and dog. 
Name the seats of predilection. 

In the colt, about the lips, nostrils, eyes, ears and 
prepuce ; in older horses I have seen them most frequently 
about the nose, on the belly and legs. In the dog, about the 
lips, eyelids, ears, cheeks, anus, prepuce, legs, and upon the 



TUMORS 117" 

mucous membrane of the mouth. It seems that water spaniels, 
are predisposed to them, as the vast majority of papillomata, 
upon the mucous membranes of the mouth was met with in 
this animal, hundreds of papillomata densely packed upon 
the mucous membrane lining the cheek having been seen in 
patients of mine. Those upon the mucous membrane were 
soft, yet not vascular, while those ordinarily encountered are 
of variable size and basis, covered with horny epithelium, the 
surface resembling a straw or mulberry. 

In cattle, the head, neck, along the spine, shoulders, teats 
and udder. They vary greatly in size ; those about the udder 
and teats, as a rule, thin and slender, or short, stubby and 
smooth ; in other places they are rough, bosselated and 
covered with a heavy coat of horny epithelium, with broad or 
small basis. Papillomata of the mucous membranes of the 
pharynx, oesophagus and bladder have also been observed. 

Give the treatment of papillomata. 

They can either be cut or twisted off. Caustics, while 
not as surgical and safe, are also employed. I managed to 
have very prompt results in the treatment of the South 
Carolina outbreak with large doses of potassium iodide and 
arsenic. 

Adenomata — Glandular Tumors. 

What are adenomata 9 

They are innocent growths, composed of tissue closely 
resembling glandular tissue, originating from pre-existing;, 
glandular tissue. 

What forms of adenomata are recognized 9 

1. The acinous type. 

2. The tubular adenoma. 



118 TRINCIPLES OF VETERINARY SURGERY 

Are adenomata absolutely innocent 9 

They are not ; there seems to be a slight tendency to a 
conversion into carcinomata. 

Describe the adenoma. 

They originate from a secreting gland ; are of variable 
size ; are encapsulated ; single, but may be multiple ; are of 
slow growth and do not disseminate. Usually they are firm, 
to the touch unless cysts have developed in them ; appear 
usually as mixed tumors, being rare as pure adenomata. The 
acinous form is made up of acini, which communicate with 
each other by duct-like channels, the acini being lined with 
spheroidal epithelium. The tubular adenoma is composed of 
tubules lined with cylindrical epithelium. 

How common are they in animals 9 

On the whole they are not often seen, excepting the 
adenoma of the thyroid gland of young dogs (stroma hyper- 
plastica simplex) ; more rarely in the horse. 

Oive the treatment of adenomata. 

In animals the hyperplastic stroma, especially in the dog, 
is about the only form of adenoma coming into consideration. 
In the horse removal of the thyroid is well borne, while in the 
dog removal of both lobules leads promptly to death in four 
to five days after the operation. The removal of one lobe (the 
largest one) is also well borne by the dog. In the dog, there- 
fore, internal medication with iodide of potassium with 
external iodine application, or injections of diluted tincture 
of iodine, is employed with fair results. 

Cysts. 

What is a cyst 9 

It is a bag-like neoformation, containing either fluid or 



TUMORS 119 

semi-fluid, hemmed in by a fibrous lining, covered either with 
endo or epithelium. 

What forms of cysts are recognized ? 

1. Degeneration cysts. 

2. Exudation cysts. 

3. Extravasation cysts. 

4. Retention cysts. 

5. Cysts of congenital origin. 

6. Genuine cysts. 

Describe degeneration cysts. 

These are cysts arising in pre-existing tumors, due to 
fatty, mucoid, etc., degenerations taking place in the tumor. 
These cysts contain mucoid or fatty, etc., fluids, and are 
usually observed in sarcomata and carcinomata, and then 
called cysto-sarcoma, cysto-fibroma, etc. 

Desfiribe the exudation and extravasation cysts. 

When a soft part is exposed to a contusion of sufiicient 
severity, a hematoma or lymph extravasation occurs. Asa 
result of the aseptic inflammation which follows, this fluid 
becomes encapsulated, and a hollow neoformation containing 
serum is the result, being in this instance an extravasation of 
blood cysts. 

The exudation cyst is the result of excessive secretion into 
a closed cavity, as a bursa, tendon, sheath, etc. , usually the 
result of a previous inflammation. 

Give examples of both. 

The extravasation cyst is seen about the neck and back of 
dogs after bites or on the haunch of the horse after blows. 
The exudation cyst is seen in the capped hock and capped 
elbow of the horse. 



120 PRINCIPLES OF VETERINARY SURGERY 

Describe the retention cyst ? 

These are the result of the retention of the secretion of a 
gland. 

What forms of retention cysts are recognized f 

1 . The sebaceous or atheromatous cyst, due to the dilata- 
tion of a sebaceous gland. Seen in the skin of the horse above 
the false nostril and internal canthus of the eye ; in the dog, 
in the skin of the back. 

2. Mucous cysts are due to the dilatation of a mucous 
gland. They may occur wherever a mucous gland exists. In 
the horse, ox, nd dog the retention cyst of the sublingual 
gland below or on the side of the tongue is termed ranula ; 
retention cysts are further observed in the vagina of cows 
(Bartholinine's gland); also on the lips in the trachea nasal 
cavity. 

Retention cysts of large glands, due to the closure of a 
number of ducts or of the main duct, especially seen in the 
mammary gland of the cow, is termed a lacteal cyst. 

Describe the congenital, or dermoid, cyst. 

These are due to the inclusion of a bit of the epiblastic 
layer in the mesoblast ; the wall of such a cyst may show all 
the histological features of the skin. Dermoid cysts are met 
with at the base of the ear of horses and cattle. A little 
fistulous opening with a glairy discharge is seen ; the opening 
leads to a cystic cavity containing a tooth. 

Describe the genuine cyst. 

These, also termed cystomata, are epithelial neof ormations 
in glands with cyst formation. They have been observed in 
the parotid, mammary gland, thyroid gland and ovaries. 



TUMORS 121 

Grive the treatment of cysts. 

The essential feature is the removal of the lining sac. If 
any part remains it will simply proliferate, and the trouble 
returns. This holds good especially with the sebaceou-s and 
mucous cysts. The operation for dermoid cysts consists in 
the removal of the tooth, if necessary with hammer and chisel, 
and a thorough curetting of the cyst walls. 

Infectious Neoformations. 

ACTINOMYCOMATA. 

What is an actinomycoma 9 

It is an infectious new-growth, caused by the ray fungus 
or actinomyces. 

What organs are subject to actinomycotic infections 9 

Any part of the body may become infected. In America 
the seats of predilection are the upper and lower jaws, the 
parotid gland and the region of the throat ; in England, the 
tongue ; in Denmark, the soft parts of the head ; and in 
Germany, the pharynx and bones of the jaw. 

Describe the diagnostic features of the actinomyces fungus. 

Imbedded in the soft part of the tumor or in the abscess, 
they appear as pale-yellow to sulphur-yellow minute grains 
macroscopically. With a magnification of 250 diameters, the 
grains are seen to consist of roundish masses of club-shaped 
bodies radiating from the centre. 

Describe the actinomycoma. 

Upon the part attacked depends the amount of connective 
tissue it possesses. The consistency of the tumor may be 
firm or soft. The growth of the tumor is slow. When 
arising in the soft parts of the head, a rather firm swelling 



122 PRINCIPLES OF VETEEINARY SURGERY 

is seen, from wliicli one or more nut to egg sized tumors pro- 
ject. These tumors eventually break through the overlying 
skin and appear reddish, fungoid-like masses. Then, again, 
the original swelling becomes an abscess, bursts, discharging 
a creamy pus, the abscess cavity later filling with a fungus- 
like growth, eventually projecting beyond the opening 
through which the pus was emptied. The tumors seen in the 
pharynx are either pedunculated or have a broad basis, inter- 
fering with respiration and deglutition. When invading the 
bone, the latter enlarges decidedly. The actinomycotic 
growth may grow outward, break through muscle and skin, 
and appear as a mushroom-like mass, or the growth may take 
an inward course and appear in the mouth. 
What forms of actinomycosis are observed ? 

External, internal and generalized — the latter very rare. 
What animals are liable to actinomycosis f 

Primarily, cattle ; at times, horses, swine and sheep. 

Hotv are animals infected ? 

Usually through the ingestion of actinomyces-bearing 
food coming in contact with wounds of the mucous mem- 
brane of the mouth. 
Describe actinomycosis of the bones. 

Maxillary bones of cattle : The disease takes its start in 
the gums near a tooth, leading to an ossifying periostitis with 
formation of an exostosis. In those cases where the actino- 
mycoma spreads to the marrow, a rarefying osteitis results. 
In both the ossifying periostitis and rarefying osteitis, the 
superior and inferior maxillary bones become greatly en- 
larged. After having invaded the bone, the actinomycotic 
granulation tissue may appear in the mouth, loosening teeth, 
or may even extend into the maxillary or frontal sinuses. 



TUMORS 123 

Of otlier bones, the following have been reported as 
actinomycotic : Sternum and ribs, vertebrae of the back and 
neck. 
Describe actinomycosis of the pharyngeal cavity. 

These soft tumors may resemble a polypus, being 
pedunculated, hanging from the mucous membrane ; are of 
pea to egg size, or they may have a broad base and be of 
fungoid shape. Similar neoformations are seen upon the 
mucous membrane of the larynx, trachea, vagina, intestines 
and nasal cavity. 
Discuss actinomycotic lymph glands. 

Those most frequently involved are the subparotid and 
submaxillary glands. Actinomycosis of lymph glands is 
never primary, but always of metastatic — that is, secondary — 
origin. The gland enlarges, is firm, oval or round, and 
painless, varying in size. 

Actinomycotic salivary glands are also seen occasionally. 

Actinomycotic submaxillary lymph glands have been 
seen in the horse. 

Discuss actinomycosis of the skin and suhcutis. 

More commonly seen about the head, udder, neck, 
abdomen, etc. They are both primary or secondary, the 
former arising from an infected skin wound, the latter from 
deeply seated actinomycotic processes which have broken 
through. They appear in the shape of nut to fist sized 
tumors, or as soft, reddish, fungoid masses. Fistulous open- 
ings may be present. Actinomycomata have been seen in 
castration wounds of pigs and in the spermatic cord of oxen 
and geldings. 

Discuss actinomycosis of the mammary gland. 

Those of the sow, where they are oftenest seen, appear as 



124 PBINCIPLES OF VETEBINARY SUKGERY 

pea-sized nodules, containing pus and detritus, the nodule 
Toeing surrounded by a zone of firm connective tissue. Instead 
of the nodules, abscesses may be met with. 

In the cow one or more quarter of the udder is hard, duft 
to fibrous proliferations of the interstitial tissue, soft, pus« 
containing nodules being found here and there in the hyper- 
plastic quarter. Actinomycosis of the whole udder is com- 
paratively rare. Such an udder is hard and knobby, enlarged 
as a whole;. When cut into, the surface exhibits numerous 
little yellowish spots, each spot containing«a trifle pus. 

Discuss actinomycosis of the muscles. 

Statistics furnish one case where the elbow and shoulder 
muscles were actinomycotic. They are of metastatic origin, 
following skin actinomycosis. 

Discuss actinomycosis of the tongue. 

This form is quite rare in America, being quite prevalent 
in England and Germany. As a rule, the tumors are 
multiple, invading the whole organ. They produce marked 
induration, the result of severe connective tissue proliferation 
(Glossitis indurativa actinomycotica). Such a tongue is 
deformed, greatly enlarged and feels hard, for which reason 
it is termed "wooden tongue'^ in Germany. Somewhere 
upon, below or on the side of the tongue (usually the latter), 
one sees brownish spots, which are circumscribed, containing 
minute yellowish nodules. 

In between the muscle fibres and beneath the mucous 
membrane are firm, fibrous actinomycomata of pea to nut 
size, which, when cut into, are seen to be filled with a cheesy, 
yellowish material. As a rule, the regional lymph glands 
show metastatic changes. 

Actinomycosis of the internal face of the lips is character 



TUMORS 125 

ized by brownisli actinomycomata. A very few cases of 
lingual infection in tlie liorse are on record. 

Describe the ireatment of actinomycosis. 

Those tumors wliich can be removed with, the knife should 
1)6 attended to in that way, otherwise the excellent results 
obtained by the specific action of iodide of potassium demands 
its employ. 

BOTRYOMYCOMA 

yVTiat is a hotryomycoma ? 

An infections new-growth caused by the invasion of 
Ijotryomyces. 

Under what other names are the hotryomyces Tcnown ? 

Botryococcus, micrococcus bitryogenus, micrococcus 
ascoformans. 

Do all investigators agree upon the hotryomyces as the cause of 
hotryomycomata ? 
They do not. Some claim that the micrococcus ascofor- 
mans is not a specific germ, but simply a pus coccus. 

What is the nature of the hotryomycoma ? 

This neoplasm, also termed mycofibroma, represents a 
chronic inflammatory connective tissue proliferation produced 
by the hotryomyces. 

What animals are subject to botry oomycosis ? 

Primarily, the horse ; occasionally, the ox and swine. 

What mycofibromata are of interest to the surgeon ? 

Those in the skin and subcutis, muscles, mammary gland 
and spermatic cords. 



126 PRINCIPLES OP VETERINARY SURGERY 

Describe the hotryomycoma of the skin 9 

They are either solitary or multiple, from pea-sized 
nodules up to man's-head size, tlie largest ones being almost 
always met with, in the scapulo-humeral articulation and 
about the elbow. The tumor is of firm consistency, but may 
show soft iDortions here and there, with fistulous tracts 
extending into its interior. It cuts quite hard, the knife 
creaking as it passes through. The cut surface has a fibrous 
appearance, and shows here and there little cavities filled with, 
a yellowish mucoid fluid and pockets filled with pus . 

What cutaneous regions are principally involved 9 

All parts exposed to harness pressure, elbow, point of 
shoulder, tail, lips and fetlock. 

Does the skin hotryomycoma confine itself to the skiri only f 

The larger tumors of this sort after developing in the 
skin invade the deeper organs. 

Describe the hotryomycoma of the spermatic cord. 

This condition is commonly termed scirrhous cord or 
champignon. At the time the animal is castrated, the castra- 
tion wound becomes infected with the botryomyces and a 
funiculitis botryomycotica is the consequence. It sets in by 
not healing of the castration wound, which continues to 
discharge pus. Now and then an acute cellulitis follows, 
alarming the owner, who usually at this stage seeks profes- 
sional advice. This cellulitis always sets in when the opening 
through which the i)us is discharged closes up, to disappear 
as soon as a new perforation is established allowing the pus 
to escape. This condition may persist for years without 
leading to serious consequences. The spermatic cord as a 
whole, or only its distal end, shows a rather painless, hard 
swelling. The vaginal process and the cord and surrounding 



TUMORS 127 

tissues all form one solid mass, the skin at the most dependent 
part showing fistulous openings leading into tracts of various 
depths. 

On section, the surface is grayish white, showing here 
and there softened foci containing a muco-purulent semi- 
fluid holding the hotryomyces. 

Describe the hotryomycoma of the mammary gland. 

This is of rather malignant disposition, very likely to 
recur after excision, and has a decided tendency to invade the 
surrounding tissues. The part of the udder involved feels 
hard and nodular ; there may be fistulous openings and 
abscesses present, the affection occasionally spreading to the 
abdominal parieties and thigh. 

Describe the botryomycoma of muscles. 

These are quite often seen at a point where the mastoid© 
humeralis covers the point of the shoulder, representing a 
form of the so-called shoulder abscesses. They differ but 
little from those described under botryomycoma of the skin. 
Other muscles in which they are observed are those of the 
belly, intercostal muscles. Botryomycosis of bones seems to 
be very rare. One case is on record where the tumor 
developed from the maxillary sinus. This tumor, springing 
from the n^ucous lining, became as large as a child's head in 
two months, causing a bulging of the maxillary and frontal 
bones, unilateral nasal discharge and nasal dyspnoea. Gen- 
eralized botryomycosis has been described once ; it was a 
mare, the primary i)oint of infection being the uterus. Those 
botryomycomata found in internal organs have no practical 
surgical interest. 

How do you treat botryomycomata 9 

They are best excised, carrying the knife well into the 



128 PEINCIPLES OF VETERINARY SURGERY 

healthy tissues to prevent recurrence. In case the mammary 
gland is involved, it is best to amputate the whole gland. 
The same is done with the scirrhous cord. Those cases where 
a multiple botryomycosis is present, are operated from time 
to time, as it would be out of the question to remove all 
neoformations in one sitting. More recently medication with 
iodide of potassium and external applications or injections of 
tincture of iodine are reported to have given very satisfactory 
results. 



TUBERCULOSIS. 

What is tuberculosis 9 

An infectious disease due to the presence of the bacillus 
of tuberculosis in the tissues of the body. 

Is tuherculosis of the domestic animals of much surgical 
interest 9 
It is not, for various reasons. First, tuberculous disease 
of the external organs of animals is not of frequent occur- 
rence. Second, those operations of great value in man, as, for 
instance, resection of a tubercular joint, are not to be thought 
of in animals. Third, those animals where tuberculosis is 
more frequently encountered (ox, swine) are for slaughter, 
the tuberculous lesions exhibited by them being either of a 
localized, external description, and then of little practical 
moment, or the lesions are secondary and the result of 
generalized tuberculosis, in which case they are incurable. 

Which forms of tuberculosis are of practical surgical interest ? 
Tuberculosis of the mammary gland, lymph glands, skia 
and subcutis, mucous membranes, bones and joints, muscles, 
eye, testicles, brain and spinal cord. 



TUBERCULOSIS 129 

Describe the tubercular mammary gland. 

The diseased process consists either of a localized tubercu- 
losis, tuberculous mastitis or diffused miliary tuberculosis. 
The bacillus rarely enters through the teat, thus creating a 
primary tuberculosis ; in most cases it is of embolic origin — 
that is, secondary. Such an udder, of which usually the 
posterior quarter is at first diseased, shows a diffused, hard 
swelling, which is little painful, with enlargement of the 
regional lymph gland and supra-mammary lymph glands. 
As the disease advances, hard nodules develop in the swollen 
quarter ; finally the whole udder may attain a large size and 
show the same symptoms just mentioned. In regard to the 
lacteal fluid, it must be said that in the earlier stages it under- 
goes no visible changes, only later it becomes watery and 
flocculent, containing the specific bacillus. 

Describe tuberculosis of the lymph glands. 

The affected lymph gland enlarges and becomes hard, 
explained by the process of calcification the tubercle under- 
goes and the proliferation of the interfollicular connective 
tissue of the gland. Infection of the lymph gland takes place 
both by the blood and lymph vessels. 

Name the lymph glands most commonly involved. 

Those in the intermaxillary space and those near the 
parotid gland, the retropharyngeal ; those of the cervical 
region, the prescapular, axillary, and those near the elbow, 
the inguinal, popliteal and precrural, the supra-mammary 
glands. Of the lymph glands of the internal organs, the 
bronchial ones alone are of interest, as, by becoming enlarged, 
they may compress the oesophagus and produce tympanitis. 

Describe tuberculosis of the skin and subcutis. 

This is but occasionally seen in cattle. They appear at 



130 pr.iNCirLEs of veterinaky surgery 

first as swellings from nut to fist size, become soft and exhibit 
a cheesy material containing the tubercle bacillus. In the 
dog, nlcers on the neck involving the regional lymph gland 
have been observed. 

Skin tuberculosis has been frequently observed as a 
primary lesion about the head, and here especially about the 
eye and commissure of the beak of the parrot. They aro 
either soft tumors from pinhead to egg size, of globular shape, 
or skinhorn-like excrescences in the skin ; tubercular ulcers 
containing the bacillus are also observed. 

Describe tuberculosis of the mucous membranes. 

In the shape of ulcers or mushroom-like mass, it is 
observed in the larynx and trachea of cattle. Upon the nasal 
mucous membrane of cattle one sees occasionally an aggrega- 
tion of small, lardaceous looking nodules, which may become 
confluent and form an ulcer, there being also nasal dyspnoea 
and discharge. Uterine tuberculosis (endometritis caseosa 
tuberculosa) is not rare. In the parrot, tubercles and ulcers 
are seen upon the mucous membrane of the mouth and e3'e. 

Describe tuberculosis of the bones and joints. 

Tuberculosis of the bones is usually secondary, that is, it 
is caused by a tubercular embolism ; therefore, starting in the 
marrow, an osteomyelitis granulosa is the result. 

The bones more frequently involved are the tempoi-al 
bone, sternum, cervical, dorsal and lumbar vertebrae, and ribs. 
In tuberculosis of the middle ear (otitis media and interna 
tuberulosa) in swine, the infection takes its origin in the 
pharyngeal cavity and reaches the cavity of the middle ear via 
the Eustachian tube, creating here a tuberculos osteomyelitis, 
next periostitis and rarefying osteitis, necrosis of the bono 
now reaching the meninges, and finally brain. In goats. 



TUBERCULOSIS 131 

sheep and horses, tuberculosis of vertebrse and ribs has also 
been reported. In fowls, tuberculosis of the bones is not a 
rare occurrence. 

Tuberculosis of articulations has been most frequently 
observed in fowls, that of the carpus and tarsus in swine ; 
while in cattle, tuberculosis of the hip, stifle and knee joints 
are less frequently seen. 

Describe tuberculosis of muscles. 

This form is of little surgical moment, being, as a rule, of 
an embolic nature, therefore the result of generalized 
tuberculosis. They appear as brownish nodules, of pinhead 
to bean size, usually circumscribed and arranged in rows, the 
muscles usually involved being the abdominal, thigh and 
pectoral muscles. Tuberculosis of the tongue is seen in 
parrots and at times in cattle. 

Describe tuberculosis of the eye. 

This is also an embolic form, and of rare occurrence in 
the ox, attacking the iris and choroid, eventually destroying 
the eye and changing it into a cheesy or granulating mass. 

Discuss tuberculosis of the testicles. 

This leads to enlargement of the glands. On section, pea 
to nut sized tubercles are seen. Tuberculosis of the spermatic 
cord, tunica vaginalis and prostate gland have also been 
observed. All these are comparatively rare ; those of the 
testicles are reported in the bull and boar, that of the prostate 
have been observed in the bull and dog. Tuberculosis of the 
ovaries seems to be quite frequent. 

Discuss tuberculosis of the brain and spinal cord. 

These are of interest from a standpoint of differential 
diagnosis, as they give rise to symptoms of paresis or 



132 PKINCIPLES OF VETEEINAEY SURGERY 

paralysis, while tuberculosis of tlie spinal cord may produce 
locomotor ataxia or paraplegia. 

Describe the treatment of tuberculosis ? 

Generally speaking, such patients are not treated, for 
obvious reasons ; while in disease of the testicles or ovaries 
castration or spaying may be attempted. 



CONCRETIONS AND FOREIGN BODIES. 

What is a concretion ? 

A stone-like mass, a sediment of an earthy basis from 
retained secretions or excretions of the body. 

Enumerate the concretions of surgical interest. 

1. Renal calculi. 2. Intestinal calculi. 3. Salivary cal- 
culi. 4. Lacteal calculi. 5. Preeputial calculi. 6. Rice 
kernel calculi. 

Where do you find renal calculi ? 

In the kidney, pelvis of the kidney, bladder and urethra. 

What is their compositio7i f 

Silicates, urates, triple phosphate, carbonate and oxalate 
of lime, etc. 

Hotu are they formed f 

1. As a result of disease of the renal mucous membranes, 
colloids (mucus, epithelium, blood, pus) are present. These 
colloids form a nucleus around which the earthy salts of the 
urine are precipitated, eventually becoming calculi. 

2. Through the agency of bacteria, which, by producing 
an ammoniacal fermentation, bring about precipitation of 
triple phosphate. 



CONCRETIONS AND FOREIGN BODIES 133 

Describe the urinary calculi of the various animals. 

Horse : There are two kinds, those of the bladder and 
those in the urethra. Their composition is about the same, 
consisting of traces of iron, oxalate of lime and a greater 
amount of carbonate of lime. The vesical calculi are of nut 
to list size, are hard, either egg or disc shaped, with a smooth 
or mulberry-like surface and of yellowish color. One oi- 
several stones, as well as a finer sediment ("gravel "), may be 
found. The urethral calculi are usually found at the ischial 
curvature and are of pigeon egg to chestnut size. 

Cattle : These are composed of carbonate and oxalate of 
lime. As a rule, a number of round or disc-shaped pea-sized 
stones, glistening and yellowish, are found at the curve of the 
urethra. 

Dog : These are usually small, of pea size and present in. 
numbers. The surface may be rough or by continuous rub- 
bing may have become smooth. They are composed of 
oxalates, urates and triple phosphate, filling the whole urethra^ 
being wedged at the incur vated portion of the penial bone. 

Describe intestinal calculi. 

These are also known as enteroliths in the horse and are- 
of little surgical interest unless they can be reached from the- 
rectum. They are found in the caecum and colon, causing 
obstruction and colics. They are primarily composed of triple 
phosphate, formed by the precipitation of the phosphate of 
magnesia (coming from the food ; bran, for instance) by the 
ammonia found in any barn. The ammoniaco-magnesium 
phosphate and calcium phosphate — that is, the triple phos- 
phate — crystalizes around a kernel of oats or any other foreign, 
body, and the foundation to a calculus is laid. 

In cattle the so-called hair balls are quite often found in 
the rumen. These are also called bezoars and are made up of 



134 PRINCIPLES OF VETERINARY SURGERY 

plant fibers or hairs. As a rule they cause no inconvenience, 
but may, when regurgitated, become lodged in the oesophagus 
and give rise to symptoms of choke. 

Describe salivary calculi. 

They are seen in horses and cattle, especially in Stenos 
duct. Single stones are of oval shape, while multiple ones 
are variously shaped as the surf aces which are in contact with 
each other are ground down. In the center there is usually 
some foreign body, as a bit of straw or an oat kernel, which 
forms the nucleus to the whole. They vary from pea to egg 
size and are composed mainly of carbonate of lime, some 
phosphate of lime and organic substances ; they have a white 
to pale yellow color. 

Describe lacteal calculi. 

These concretions, found in the teat or milk cistern of the 
udder, are made up principally of carbonate of lime with 
some fat and casein. They are of variable shape, may 
become as large as a hazel nut and range in color from pale 
yellow to gray. Clogging the channel through which the 
milk is emptied, it becomes of surgical interest. 

Describe iweputial calculi. 

These are observed in the urethral sinus of the penis and 
in the prepuce proper, the former being commonly termed 
''beans," which when attaining a certain size may obstruct 
the flow of urine. They are smooth, oval concretions mainly 
consisting of inspissated smegma. 

Describe the rice Jcernel bodies. 

These peculiar formations, also known as corpora libra, 
chondroids, are of organic origin, representing coagulated or 
inspissated or calcified products of inflammation or bits of 



CONCKETIONS AND FOREIGN BODIES 135 

neoformations, bone or cartilage. They are found in the 
guttural pouches, tendon sheaths, bursse and articulations. 

Hoiv do you treat the various calculi ? 

Urinary calculi are subject to operative measures — 
namely, by cystotomy and urethrotomy. Intestinal calculi 
in horses are, as a rule, beyond reach, if not beyond a positive 
diagnosis. Hair balls in cattle, when giving rise to choke, 
are treated as such. Salivary calculi are removed by opening 
the salivary duct and extracting the stone. The same refers 
to lacteal calculi. Preputial calculi can be easily removed 
by hand. The treatment of corpora libra is discussed under 
its respective head. 

Foreign Bodies. 

What are foreign bodies ? 

Any irritant entering the tissues of the body from with- 
out. 

In luhat parts of the body are foreign bodies of surgical 
interest 9 

Buccal cavity, pharynx and oesophagus, stomach and 
intestines, respiratory apparatus, eye and ear, hoof, skin, sub- 
cutis, muscles, bones and internal organs. 

Where do you find foreign bodies in the mouth 9 

In, beneath and around the tongue, between the teeth, 
mucous membranes of the cheeks, palate, openings of the 
ducts of salivary glands. 

What symptoms are they likely to produce 9 

Ptyalism, chewing motions, quidding of food (difficult 
mastication), stomatitis and rabiform attacks (dogs). 



136 PRINCIPLES OF VETERINERY SURGERY 

Enumerate some of the foreign bodies met ivith in the mouth. 

Splinters, needles, pieces of bone, fish, hooks, rubber 
bands, sprouting seeds (a regular lawn was seen upon the f aco 
of the tongue of a cow). In the ducts of glands, bits of straw, 
kernel of oats, barley. 

A dog is on record with a piece of metal in the Eustachian: 
tube and a horse with a piece of straw, having worked its 
way up the lachrymal duct. 

What animals are more commonly the subject of foreign, 
bodies in the mouth ? 
Dog, cat, cattle ; less frequently the borse. 

What symptoms do foreign bodies of the pharynx and oesoph- 
agus produce ? 
Difficult deglutition, pharyngitis and choke. 

What foreign bodies are usually met here ? 

In horses : Corn cobs, potatoes, turnips, apples, food 
boluses, pieces of a whip ; in the guttural pouches, accumula- 
tions of food. 

Cattle : The above and also hair balls, tin cans, pieces of 
metal, cloth, pieces of afterbirth, bacon rinds, beefsteaks 
(given empirically as an artificial cud). 

Dog : Bones, needles, fishbones, large pieces of meat ; in. 
playful dogs, spools, stones, etc. 

What serious sequels may these produce ? 

Perforation of the pharynx, rupture of the oesophagus 
and consequent internal hemorrhage from injury of the 
aorta, or pleurisy. 

What foreign bodies are seen in the stomach of cattle ? 

An endless variety ; all the way from horse rake teeth- 
down to needles, nails and stones. 



CONCRETIONS AND FOREIGN BODIES 137 

What effect do they have upon cattle ? 

As a rule they do not cause any inconvenience, only wlien 
sharp and long enough they perforate the wall of the organ 
holding it ; thus they perforate the diaphragm, pericardium, 
and injure the heart, causing serious disease of the digestion 
and heart (traumatic gastritis and pericarditis). 

What foreign bodies are observed in the stomach and intes- 
tines of the dog ? 

Bullets, balls, coins, spools, etc. 
What symptoms do they give rise to 9 

Sometimes none at all ; then again more or less anorexia, 
emesis, constipation, great restlessness, or great dejection ; in 
other words, symptoms suggestive of intestinal obstruction. 

What foreign bodies are seen in the rectum and urethra ? 

In the rectum of the dog any of the previously-mentioned 
foreign bodies may be seen ; in the horse, pepper, lumps of 
salt herring (introduced by empirics). In the urethra of the 
horse I found a piece of a catheter. 

W hat foreign bodies are found in the respiratory apparatus 9 
Accumulations of food in the maxillary sinus ; in the 

nasal cavity, food, sponges, cotton, etc., placed there by jib- 

bers to hide nasal discharges of the horse. In the trachea,. 

pieces of cartilage aspirated during tracheotomy, pieces of the 

tracheotomy tube, oil, especially when drenched through the 

nose. 

What symptoms do they produce ? 

Purulent nasal discharge, usually unilateral when the 

sinus is affected, or violent fits of coughing at first, with 

subsequent symptoms of a foreign body pneumonia in case 

the foreign body entered the trachea. 



138 PRINCIPLES OF VETERINARY SURGERY 

What symptoms do foreign bodies of the eye and ear give 
rise to 9 

Eye : Depending on the nature of the irritant (bits of 
straw, hay seeds, etc.) and length of time they are present, 
the symptoms of a chronic purulent conjunctivitis are there, 
especially so in the horse when the foreign body is beneath 
the membrana nictitans. 

Ear : The oif ending agent is usually a parasite, as lice or 
mange parasites. 

What foreign bodies most commonly enter the hoof 9 
Nails and glass. 

What portion of the hoof is more frequently involved f 
The commissures of the frog. 

What symptoms do they give rise to 9 

Lameness, the result of pain due to pododermatitis. 

Describe the actions and results of foreign bodies in the shin 
and in underlying parts. 
Such foreign bodies may be bullets, shot splinters, etc. 
The most important feature lies in the fact whether they carry 
infection into the tissue which they enter or whether an 
aseptic wound is produced. Bullets, unless carrying bits of 
the harness or hair into the deeper parts, may become encap- 
sulated, creating no further sequels. Those causing infection 
of the parts give rise to pus production, as abscesses or more 
or less serious cellulitis. Foreign bodies of animal origin and 
introduced by the surgeon (catgut) become liquefied and are 
absorbed. 

Of what surgical interest is air as a foreign body 9 

When animals are bled (phlebotomy), it is possible that 



CONCRETIONS AND FOREIGN BODIES 139 

air may enter tlie vein and when of sufficient amount may 
produce death by arresting the heart. 

Outline the treatmeiit for foreign bodies . 

Those in the mouth are simply extracted with the fingers 
or forceps. Those in the pharynx of horses and cattle I have 
frequently removed by directing a stream of water from a 
handpump against the wedged masses (with proper care and 
judgment). In the dog, they are removed with a forceps or 
an emetic (apomorphine). In the horse, sialagogues, as areco- 
line and pilocarpine, may also be used. Those which are in 
the oesophagus are pushed into the stomach with the probang 
(an easy thing in the ox but much more difficult in the horse). 
At other times cesophagotomy or modifications of that opera- 
tion are indicated. Of course those cases where the pharynx 
or oesophagus are perforated are beyond remedy. Foreign 
bodies in the guttural pouches are best removed by Merillat's 
operation (opening the pouch through the soft palate). Those 
in the stomach — that is, the rumen — of the ox may at times 
"be removed by rumenotomy. Those in dogs, unless they 
come away with an emetic, or, if in the bowels, with a purge, 
may be removed by enterotomy, which when properly done is 
borne very well by the dog. Those in the respiratory appar- 
atus (the nasal cavity) can be removed with the fingers or 
forceps. Those in the sinuses by trephining them. Those in 
the trachea are usually beyond reach. Those in the eye may 
be washed out with a soft rubber syringe or picked up with a 
forceps. Those of the ear usually require an antiparasitic 
treatment. Those of the hoof are simply pulled out when 
present and good drainage and antisepsis are employed. 
Those in the skin and underlying parts are removed when m 
situ, unless it is reasonable to presume that an aseptic pro- 
cess of healing is possible, as in some gunshot wounds. 



140 PRINCIPLES OP VETERINARY SURGERY 

Which foreign bodies of parasitic origin are of interest to the 
surgeon ? 

In the horse : 1. Filaria Papillosa. Found in the anterior 
chamber of the eye, giving rise to iritis and keratitis. Treat- 
ment consists of operative measures. This parasite has also- 
"been found in cryptorchids and hydrocele. 2. Filaria cincin^ 
nata. Occasionally causes a tendinitis in Russian horses. 
3. Filaria medinensis. Seen in the subcutis of horses ia 
tropical countries, as East India, Africa, etc. It causes a 
form of elephantiasis (strongulus armatus). Has been found 
in the hypertrophied nasal mucous membrane. 4. Sarco^ 
sporidia. When present in great numbers give rise to aa 
interstitial myositis. 

In cattle : 1. Coe,nurus cerebralis. Produces symptoms of 
iDrain disease, as vertigo, wabbly gait, blindness, even para- 
plegia. Treatment by trephining. 2. Hypoderma hovis, 
Forms nut sized tumors, each tumor representing an abscess 
containing the larva. Treatment : Split the abscess and 
squeeze out the contents. 

In sheep : 1. Ccenurus cerebralis. Same as in cattle. 
2. CEstrus ovis. Located in the nasal and maxillary sinuses^ 
giving rise to a chronic catarrh of the mucous membranes of 
those parts. Treatment consists in blowing some mild irri- 
tant into the nasal cavity, or for those in the sinus by" 
trephining, with subsequent irrigation of frontal sinus. 

In swine : The Cysticercus cellulosce has been found in 
the eye. 

In the dog : 1. Pentastomum tmnioides. In the nasal 
cavity and frontal sinus, causing a purulent rhinitis. Treat- 
ment : Trephine frontal sinus and inject benzine. 2. Filaria. 
medinensis. In the subcutis, producing a form of elephan- 
tiasis in dogs of tropical climes. 3. Spiroptera sanguino^ 



HEKNIA AND PROLAPSUS 1-11 

Jenta. Seen in Java, producing cysts in tlie walls of the 
cesophagus. 



HERNIA AND PROLAPSUS. 

What is a hernia ? 

A protrusion of viscera through normal and abnormal 
■openings in the walls of the cavity holding it without injury 
of the skin or mucous membrane covering it. 

Speaking of a hernia, what is ordinarily meant hy it ? 

A protrusion of the abdominal viscera through abnormal 
openings of the abdominal muscles. 

What other hinds of hernia are spoken of ? 

When a muscle protrudes through a rent of che fascia 
covering it, one speaks of a muscular hernia ; in the same way 
of hernia of the brain, lungs, etc. 

Jn regard to position, what varieties of hernia are known ? 

Umbilical, inguinal, ventral, scrotal, perineal, dia- 
phragmatic, femoral, vaginal, pelvic. 

Describe the make-up of a hernia. 

(1) The opening in the abdominal cavity, termed the 
^' mouth ; " through this protrudes (2) the sac with its (3) 
oontents. 

Describe the sac. 

The sac is the pouch covering the bowel or omentum. 
That part external to the mouth of the hernia, or the main 
part of the sac, is termed the body, while the part constricted 
hj the mouth is known as the neck. 



142 PRINCIPLES OF VETERINARY SURGERY 

Classify hernias according to ilie contents of the sac. 
Enterocele contains intestines only. 
Epilocele contains omentum only. 
Entero-epilocele contains both of the above. 
Cystocele contains the bladder. 
Gastrocele contains the stomach, etc . 

Name the clinical varieties of hernia. 

1. Reducible. The contents of the sac can readily be 
returned into the abdominal cavity. 

2. Irreducible. The contents cannot be returned, due to 
incarceration or inflammatory adhesions. 

3. Incarcerated. The contents of the bowel form an 
obstruction to the return of the bowel into the abdomen. 

4. Strangulated. An arrest of the circulation of the pro- 
truded bowel, due to severe constriction at its neck. 

Hoiv are hernias classified as to their origin ? 

(1) Congenital ; (2) acquired or traumatic. 
Give the symptoms of a reducihle hernia. 

In the so-called hernial region (region of the umbilicus^ 
inguinal canal) a swelling is found, which is soft, regular,, 
round and smooth. As a rule, there are no symptoms of 
inflammation, as heat, pain, swelling of the adjacent tissues. 
The integument over the tumor can be displaced. The con- 
tents of the sac either slip from under the palpating fingers 
or have a doughy, uneven feel. In the former it contains 
bowels only; in the latter, omentum. Of course both may bo 
present together. On placing the finger against the tumor 
and pushing it toward the wall of the cavity from which 
the tumor comes, the rent in the wall or the dilated state of 
the natural canal through which it came (inguinal canal) — 
that is, the mouth of the hernia — can be felt. This varies in 



HERNIA AND PROLAPSUS 143 

size, may be round or show a split. The edge of this mouth, 
.in old hernias also termed the ring, has a firm, fibrous feel. 
In cattle this ring has been found ossified. The palpating 
fingers can reduce the hernia ; that is, can push back part 
or all of the contents of the sac into the abdominal cavity if 
the hernia be a ventral one. Percussion of the sac in case it 
contains bowels gives rise to a tympanitic sound. 

Give the symptoms of an incarcerated hernia. 

Ill the obstructed hernia most of the symptoms just men- 
tioned above are present, but there is this difference : in the 
sac, doughy feces, gases and liquids can be felt, the tumor is 
larger than ordinarily and cannot be reduced by taxis. There 
is abdominal pain. In dogs and swine, besides these symp- 
toms there may be slight vomiting. I have had two patients 
(geldings) for several years who invariably had nasty colics 
from incarcerated inguinal hernia whenever they were 
allowed to stand in the barn for a few days in succession. 
Both of these animals died subsequently, the post mortem 
examination revealing the fact that the incarcerated hernia 
had become strangulated, which diagnosis had been made at 
the time of their last illness. 

Oive the symptoms of strangulated hernia. 

More often seen in old hernias than recent ones. In the 
horse — usually the stallion of mature age — they are ushered 
in with colicky symptoms. The hernial sac is painful on pal- 
pation, and shows increased heat and cannot be reduced. 
The tumor feels tense, the animal stretches same as they do 
before stalling, or take a dog-sitting position or show other 
symptoms suggestive of intestinal obstruction ; the pulse is 
rapid and soon becomes wiry ; the facial expression is one of 
great anxiety, etc. 



144 PRINCIPLES OF VETERINARY SURGERY 

Dogs and swiue show abdominal pain, vomit ; symptoms 
of collapse soon follow ; otherwise the hernial tumor exhibits 
the same conditions as in the horse. 

Hoiv do you treat a hernia ? 

There are two methods : 1, palliative ; 2, radical. 
Describe the palliative treatment. 

Only employed in reducible hernia. Here by means of 
a truss the protruded mass is retained in its cavity, as a result > 
of which sometimes the hernial mouth becomes so small that 
the gut no longer can protrude. This method is at times of 
value in young dogs, colts and brood mares. At the same 
time it must be remembered that in the young a hernia may 
disappear spontaneously, as the bowels quite rapidly enlarge 
and become too large to pass through the hernial mouth. 
Some practitioners advise the application of blisters and 
caustics, as sulphuric acid, the actual cautery. Others, again, 
advocate the hypodermic injection of a salt solution or 
alcohol — all with a view to produce artificially an inflamma- 
tion and scar formation around the rent in the wall of the 
cavity from which the contents protrude. These latter 
methods are of doubtful value and not without danger, as it 
is known that the integument covering the hernial sac 
sloughs off, thus causing a prolapsus ; while the hypodermic 
injections have as sequels peritonitis and septic cellulitis. 

Describe the radical treatment. 

Unless the mouth of the hernia is too large (say, exceeds 
five inches in length), the hernial sac may be obliterated by 
tying it off by means of an elastic ligature, as a rubber tube 
or even a common string (do not apply it too tight or the skin, 
will slough off too soon and a prolapsus may follow) ; or by 
stitching off the sac — that is, ligate it in sections. This latter 



HERNIA AND PROLAPSUS 145 

form I prefer. Tlie above treatment lias the advantage that 
the peritoneal cavity remains closed and the dangers of a 
peritonitis are done away with, and on the whole it can be 
looked upon as a safe and reliable means. The most surgical 
treatment is herniotomy. Here of course asepsis and chloro- 
form narcosis are essentials, otherwise peritonitis is likely to 
follow. Herniotomy in the dog gives very nice results, while 
in the horse the nature of the tissues, as well as the difficulties 
accompanying asepsis, render it of doubtful value, at least in 
€very-day practice. That herniotomy can be executed suc- 
cessfully in the horse, especially in the colt, has been 
•demonstrated. 
Oive the treatment of incarcerated hernia. 

Attempt to reduce the hernia by hand (taxis). If neces- 
sary, put the animal into the dorsal recumbent position, 
assisting it by exerting traction upon the gut from within, 
that is, through the rectum. In cases of inguinal hernia in 
"the horse, since he most likely will have to be operated, put 
him upon the back and chloroform him ; abduct and bring 
well back the hind leg of the affected side. Should all this 
fail and the danger of strangulation become apparent or 
strangulation is already present, operate. Instead of widen- 
ing the hernial ring with the knife right away, puncture the 
loop of intestine presenting itself with a fine trocar and 
canula, such as is found in our hypodermic syringe cases, 
thus allowing the escape of a considerable amount of gas and 
liquid. In this manner I have succeeded frequently in re- 
ducing a strangulated hernia. When this fails, split the 
hernial ring, and re-position of the sac's contents becomes 
easy. In stallions, this is to be followed by castration by the 
covered method, while in geldings the tunica vaginalis is to 
be searched for and dissected from the bowels, which usually 



146 PRINCIPLES OF VETERINARY SURGERY 

are connected with it by adhesions ; next the tunica is twisted 
once or twice around its axis and a small curved clamp 
applied over it as high as possible. 

What varieties of hernias are more commonly met with m 
our various animals ? 

Ventral hernia : Cattle and horses. 

Umbilical hernia : Dogs and horses. 

Inguinal hernia : Horses and swine. 
Describe the individual hernias. 

Ventral hernia : The causes are traumatic ones, such as 
kicks, falls upon blunt objects (tree stumps, etc.). The 
hernia may be located at any part of the abdominal parietes, 
usually about the flanks or along the linea alba. Their size 
-varies, but may be very large. My experience with these 
ruptures is, that when the mouth of the hernia exceeds eight 
inches they are incurable. From a standpoint of differential 
diagnosis, at least in recent hernias, one must remember 
abscesses and hematomata. In small animals herniotomy 
gives nice results, while in the larger ones the clamp or 
ligature is preferable. 

Pelvic hernia (gut tie) : Seen in the ox ; mainly due to a 
peculiar method of castration, consisting of tearing the 
spermatic cord through or tearing it out by sheer force. In 
consequence of this the parietal peritoneum is lacerated and a 
pouch results ; an intestinal loop may enter it and become 
strangulated. There are colicky symptoms. By rectal pal- 
pation under right or left transverse process of the sacrum 
the constricting cord and incarcerated intestine can be felt. 
Treatment consists of laparotomy or re-position of the in- 
carcerated loop by hand per rectum. 

Umbilical hernia : Seen especially in young animals. 
Heredity seems quite an etiological factor ; the animal is 



HERNIA AND PROLAPSUS 147 

either born with the hernia or it appears soon afterwards. 
The contents of the sac are usually the colon or caecum. The 
mouth of the hernia is represented hy the umbilical ring. On 
the whole, small umbilical hernias are of little consequence, 
often disapxDearing voluntarily, the bowels becoming rapidly 
too large to pass through the abdominal opening. For this 
and other reasons this variety of hernia rarely incarcerates. 
The treatment in younger animals should be an expectant 
one unless the hernia is large. In older animals and in large 
hernias of the young animal, operative measures are indi- 
cated, as herniotomy (in the dog and colt, in the latter only 
when the ligature or clamp has failed); in older and larger 
animals the clamp or ligature are safest. 

Inguinal hernia : This may be looked upon as a danger- 
ous hernia, as, by reason of its location, incarceration of a 
descended intestinal loop quite frequently occurs. It is of 
most interest in the horse, and productive of the symptoms 
of au obstruction colic. The treatment consists in herniotomy. 
After return of the intestinal loop into the abdomen the 
animal is castrated by the covered method, the tunica 
vaginalis being twisted several times around its axis. Now a 
small and curved clamp is placed over the tunica vaginalis 
and cord and placed as near to the inguinal opening as 
possible. An important feature lies in leaving the clamp in 
position as long as possible, in order to obtain adhesions 
between the cord and tunica vaginalis, thus preventing the 
intestines from descending. 

Prolapsus. 

What is a prolapsus f 

A protrusion of viscera into the external air, through 
normal or abnormal openings of the body. 



148 PRINCIPLES OF VETERINARY SURGERY 

What is the difference between a hernia and a prolapsus ? 

In the hernia, the integuments, as skin or mucous mem- 
branes, are not injured and the protruded viscera are not 
exposed to the external air, while in the prolapsus the integu- 
ments are injured and the viscera are in actual contact with 
the external air. 

What tivo terms are often confounded luith prolapsus 9 

Inversion and invagination of a hollow organ. 
What does inversion and invagination respectively mean ? 

In inversion things are turned inside out ; for instance, 
in inversion of the bladder the organ is turned inside out, 
appearing externally through the urethra but not through a 
rent of the mucous membrane of the vaginal wall, as is the 
case in prolapse of the bladder. In invagination, one part of 
a hollow organ is drawn into another part ; in other words, 
the parts become telescoped. 

Name the causes of prolapsus. 

Traumatisms, as penetrating wounds extending into the 
abdomen or chest, resulting in prolapsus of the bowels or 
lungs ; lacerations of the vaginal walls, prolapse of the 
bladder, paralysis of the penis, prolapse of the penis, relaxa- 
tion of the broad uterine ligaments, prolapse of the vagina or 
uterus, constipation and consequent severe straining by the 
muscles concerned in defecation, prolapsus of the rectum, etc. 

Are all cases of prolapsus pure and simple those of a prolapse? 
They are not. In many instances it represents a com- 
"bination of prolapse with invagination ; in other instances 
it is a prolapse with inversion. 

Give an example of both. 

Prolapsus of the rectum is usually a prolapsus of the rec- 



HERNIA AND PROLAPSUS 14^ 

turn plus invagination of tlie rectum. Prolapsus of the- 
vagina is frequently not only a prolapsus of the vagina, but. 
at the same time an inversion of that organ. 

Describe the prolapsus 'more commonly encountered. 

Prolapsus of the Intestines. Follows penetrating wounds 
about the abdomen. The protruding bowels are usually the 
large, the small colon or the caecum. Another cause is the 
castration of ridglings (cryptorchids) through the inguinal 
canal, the bowels prolapsing either immediately or shortly 
after the animal rises. Finally, the bowels may protrude 
after herniotomy has been performed. In all these cases^ 
excepting perhaps the prolapse following herniotomy (pro- 
vided proper aseptic precautions have been taken previous to 
the operation and afterwards), the danger of septic complica- 
tions is great. The treatment consists in asepticizing the 
parts, thoroughly suturing the lacerated parts and applica- 
tion of a retention bandage wherever possible. 

Prolapsus of the Omentum. Follows penetrating wounds 
and ridgling castration. The treatment is the same as in 
prolapse of the bowels, but there is decidedly less danger. 
The protruding mass of omentum is ligated and cut off, the 
stump returned into the abdominal cavity. Since it is practi- 
cally impossible to stitch up the inguinal canal, I have had 
good results by firmly packing the cavity as high up the 
inguinal canal as possible with aseptic oakum and stitching 
the cutaneous wound. 

Prolapse of the Rectum. Follows empirical exploration 
of the rectum, prolonged diarrhoea, constipation — in fact, 
anything calling the muscles concerned in defecation into 
excessive play. Quite rare in the horse, it is seen in the cat, 
dog, and especially swine. As previously stated, it is often 
combined with invagination of the prolapsed parts. The 



150 PRINCIPLES OF VETERINARY SURGERY 

treatment for prolapse of this sort is not always successful, as 
the parts will continue to appear externally, and amputation 
may become necessary. 

Prolapse of the Uterus. Most frequently seen in the cow. 
It follows almost invariably anything which induces the 
animal to strain persistently, such as rough empirical traction 
during labor, the weight of the partly detached foetal placenta 
hanging from the vulva, etc. Sometimes considerable trouble 
is experienced in retaining the parts after they have been 
returned : so much so, that amputation of the uterus may be 
required. 

Prolapse of the Vagina. Most frequently seen in the cow 
and bitch. As causes may be given relaxation of those organs 
which fix the vagina, as, at the latter stage of pregnancy, 
cows standing on floors sloping downward, difficult labor 
with traumatic lesions of the vaginal canal. The treatment 
consists in reposition of the parts and retaining them by a 
variety of trusses. 

Prolapse of the Penis. In cases of paraphimosis the 
penis cannot be retracted and therefore becomes prolapsed ; 
as also in paralysis of the penis. This form of prolapsus is 
most frequently seen in the horse and dog. The treatment 
consists in attempting reposition of the organ by hand, next 
by antiphlogistic measures, and when they fail, in amputating 
the prolapsed portion. 

Prolapse of the Tongue. Follows paralysis or lacera- 
tions of. the muscles. Treatment is unsatisfactory. 

Prolapse of the Bulb of the Eye. Seen in large-eyed 
dogs, as pugs, following bites, etc. Treatment lies in reposi- 
tion, or, in case the life of the tissues is destroyed, in 
amputation. 



DISEASES OP BONES 151 

DISEASES OF BONES. 

Fractures. 

What is a fracture f 

A sudden forcible separation of the continuity of a bone. 

What are the causes of fracture ? 

1. Exciting or immediate causes. 

2. Predisposing causes. 

Describe the exciting causes. 

Fractures of this last class are subdivided into (a) frac- 
tures by external violence, (6) fractures by muscular action. 
In those due to external violence, as a blow, kick, etc., the 
fracture occurs at the point struck, or through transmission 
of the force by a bone or chain of bones at a distant point 
with more or less damage to the overlying soft parts. In 
those due to muscular action the bone is broken by sudden 
and violent contraction of muscles directly or indirectly 
attached to the bone. Again, those the result of external 
violence may be by direct violence or indirect violence ; the 
former occur at the point struck, the latter at a distance from 
the point of application of the force, the blow being trans- 
mitted through a bone or chain of bones. 

Exemplify the direct causes of fractures. 

Direct external violence : Fracture of the metatarsus 
from a kick. 

Indirect external violence : The animal falls and sits 
down like a dog, followed by fracture of some portion of the 
vertebral column. The animal's hoof is caught in a street 



152 PKINCIPLES OP VETERINARY SURGERY 

rail ; in trying to free itself the animal twists tlie incarcerated 
hoof, resulting in fracture of the os corona, etc. 

Muscular action : Horses when cast in a narrow stall in 
their vain efforts to rise strain the muscles of the back to the 
utmost, executing at the same time all sorts of torsion moA^e- 
ments, resulting in fracture of the vertebral column. A very 
similar thing is occasionally seen in the operating room ; 
horses when thrown for an operation will struggle violently 
when lying on the bed, calling into most active play th& 
longissimus dorsi especially, as a result of which a fracture 
of the dorsal or lumbar vertebrae is observed. Fracture of 
the dorsal vertebrse has been seen to follow sudden rearing ; 
that of the lumbar vertebrae in animak turning quickly and 
short. Overtaxing the gastrocnemii or flexors of the knee 
has been followed by fracture of the calcaneous and pisiform 
bones respectively. 

Describe the 'predisposing causes. 

To this class belong the so-called idiopathic fractures. 
In these fractures the bones seem possessed of abnormal 
fragility ; a variety of fractures quite frequently seen in the 
horse and cow, especially in certain localities, osteoporosis, 
osteomalacia and tuberculosis apparently predisposing the 
animals to fractures. Old animals are predisposed by reason 
of senile atrophy, the very young by reason of their juvenile 
bones ; those that have been ill and in the barn for a consider- 
able length of time are predisposed by reason of inactivity 
atrophy. 

Anchylosis of the vertebral column is another predispos- 
ing factor. 

How are fractures classified ? 

1. Simple : there is no open wound leading to the break. 



DISEASES OF BONES 1j3 

2. Compound : here an oj)en wound leads to the broken 
"bone. 

Name the varieties of fractures. 

(1) Incomplete, (3) complete, (3) compound. 

Describe inconnplete fractures. 

This class is represented by fractures where the continuity 
of the bone is not entirely lost — that is, the break extends 
partially through the thickness of or partially across the bone. 

As incomplete fractures are recognized : 

(a) Fissure or fissured fractures. This consists of a crack 
or split in the bone. These are quite common in the horse 
and difficult of diagnosis ; met with usually in the os suffra- 
ginis and tibia. 

(5) Green stick fracture. This is a true incomplete frac- 
ture. It is called "green stick" because the appearance of the 
injured bone is about the same as when a green stick is held 
at either end by the hands and broken across the knee, lead- 
ing to a pulling apart of the fibres on the outside while the 
concave portion — that is, the one resting against the knee — 
is compressed. In the bone, therefore, a portion of its thick- 
ness is broken while the balance is bent. Only seen in tlie^ 
long bones and ribs of very young animals. 

(c) Depression fracture : In these a portion of the thick- 
ness of a bone is crushed. This must not be confounded with 
a depressed fracture, where the entire thickness of the bone 
is crushed in. Usually seen about the cranial and facial 
bones. 

(f?) Strain fracture : Consists of the breaking off of a 
piece of a bone, due to violent contraction of a muscle, as 
the tearing off of a piece of the-os calcis through strain upon, 
it by the gastrocnemii. 



154 PKINCIPLES OF VETERINARY SURGERY 

Describe complete fractures. 

The fracture extends entirely across or tlirougli the thick- 
ness of the bone. 

How do you divide connplete fractures according to the direc- 
tion of the line of fracture ? 

Transverse : The break runs more or less at a right 
angle to the long axis of the bone. Generally caused by a 
direct force. 

Oblique : The line of fracture runs obliquely to the long 
axis of the bone. Generally due to indirect causes. 

Longitudinal : The line of fracture runs more or less 
parallel to the long axis of the bone. 

Dentated or toothed : Each broken end exhibits sharp 
points and depressions ; that is, it is serrated. 

V-shaped : Tlie upper fragment shows a triangular pro- 
jection, while the other one exhibits a notch into which the 
triangular or wedge shaped projection fits. 

T-shaped : Consists of an upper transverse or oblique 
line plus a vertical or longitudinal line of fracture. In the 
horse, most commonly seen in the os suffraginis. 

What is a midtiple fracture ? 

It is a complete fracture where either more than one bone 
is broken or where one bone is fractured more than once. 

What is a comminuted fracture ? 

It is a complete fracture with considerable splintering of 
the bone where the lines of fracture communicate with each 
other. 

Describe compouiid fractures. 

In this fracture the overlying soft parts either were 
injured from without by direct violence or from within by 



DISEASES OF BONES 155 

pieces of bone forcing themselves tlirougli tlie tissues ; or, 
finally, the injury of the soft parts may be secondary, being 
the result of necrosis from the pressure of displaced bony 
fragments, rough handling, as an animal suddenly throwing 
excessive weight upon the broken limb on account of slings 
in which it rests or slipping, or the soft tissues injured during 
the accident, slough. This variety of fracture is always 
serious, mainly on account of the possibility of infectious 
complications, as tetanus, septicaemia, necrosis. 

Transverse displacement : There is a complete or partial 
dislocation of the fragments at a right angle to their former 
normal long axis ; that is, one fragment is either in front, 
T^ehind or back of the other one, but they do not overlap each 
other. 

Angular displacement : The fragments are dislocated at 
an oblique angle to their normal long axis ; that is, the frag- 
ments form an angle with each other. 

Rotary displacement : One or the other fragment is 
turned about its normal long axis. 

Over-riding displacement : The broken surfaces overlap 
each other, thus bringing the two extremities of the broken 
"bone more closely together. 

Impaction displacement : The bone is shortened as the 
fragments are forced into each other. 

Direct longitudinal sej^aration : The broken parts are 
drawn apart in a longitudinal direction. 

Which animals furnish the most fractures 9 

In the large cities, with their ashphalt x^avement, street 
car rails, slippery roads in winter, fractures in the horse are 
common ; otherwise, kicks, running against solid objects, 
casting the animal, etc., are frequent causes. Next in fre- 
quency comes the dog ; here bites, blows, falls and being run 



156 PRINCIPLES OP VETERINERY SURGERY 

over by wagons, etc., are tlie direct causes. Finally, birds 
and swine, and occasionally the cat, furnish clinical materiaL 

Which hones are viost frequently fractured in the horse 9 

Fracture of the pelvic bones, tibia and os suffraginis 
represent about one-half of all fractures, the other half being: 
made up by the vertebrae, radius and metatarsus. 

Which bones are most frequently broken in the dog f 

The vast majority of fractures are those of the bones of 
the legs, only ten per cent, of all fractures being made up 
from fractures of such bones as the cranial, vertebral, ribs,, 
scapula, sternum. 

Which bones are most frequently broken in birds ? 
Mainly the femur, humerus and tibia. 

Which points do you take into consideration in the diagnosis^ 
of a fracture? 

1. The history, that of a fall, kick, bite, runaway, etc. 

2. Diminished or lost function and pain. When the 
bones of the extremities are broken the animal supports very- 
little or no weight at all and is moved with great difficulty. 
Loss of function, nevertheless, is not always marked, as, for 
instance, in certain fractures of the pelvic bones the animal 
can still suj^port weight with the affected leg ; in fractures of 
the ribs and in some fractures of the bones of the head there- 
is also an absence of loss of function. Pain, as a rule, is well 
marked, exhibited on palpation ; thus dogs cry out and the 
liorse will endeavor to get the affected limb out of reach of 
the one conducting the examination. Complete loss of 
function accompanies fracture of the vertebral column, 
characterized by paraplegia and complete anaesthesia, nor- 
mally enervated by that portion of the spinal column posterior^ 
to the point of fracture. 



DISEASES or BONES 157 

3. Abnormal mobility, usually in all directions. By it is 
understood an independent mobility of a part of a bone which, 
aaormally is an unbroken structure. This is detected by 
inspection and palpation. While as a rule quite readily ob- 
served in complete fractures, it nevertheless is at times ap- 
parently wanting, as in fracture of the vertebrae or in those 
fractures where the fragments are driven into each other 
'(impaction fracture) and in incomplete fractures. 

4. Crepitation. By it is understood the peculiar grating 
sensation heard or felt due to the rubbing together of the 
l)roken surfaces. This symptom is pathognomic of a fracture 
l)est detected by palpation and passive movements of the ends 
-of the bone supposed to be fractured. It is wanting when the 
T^roken fragments are very much displaced, in vertebral 
fractures and incomplete fractures. 

5. Swelling. While quite often wanting in incomplete 
fractures, it soon follows other fractures, consisting of a 
swelling of the adjacent soft tissues, either due to the lacera- 
tion of the tissues at the time the accident occurred, subse- 
quent injury by the bony fragments, or septic inflammation. 
Swelling often greatly handicaps the diagnosis of a fracture, 
obscuring such symptoms as abnormal mobility and crepi- 
tation. 

6. Injury of the skin may or may not be present, while in 
older fractures abscess formation fistulous tracts are seen. 

7. Constitutional disturbance. Rise of temperature may 
l^e due to the absorption of ferment-like materials coming 
from the disintegration of the blood corpuscles at the point of 
fracture, being an aseptic fever and slight. In complicated 
fractures, as the result of the invasion of pus-producing 
bacteria and the consequent absorption of the septic material, 
a septic fever of variable intensity and seriousness results. 



158 PRINCIPLES OF VETERINERY SURGERY 

Sometimes symptoms of internal liemorrliage are seen, the 
hemorrhage being the result of injury of a large blood vessel 
by the sharp bony fragments, occurring at times in pelvia 
fractures (obturator artery). 

'What individual symptoms are of specific value in the diag- 
nosis of fractures f 
Epistaxis, nasal dyspnoea and depression of the nasal 
bones are i)eculiar to fracture of the nasal bones. Pneumonia^ 
pleurisy and hemoptysis may follow fracture of the ribs. 
Paralysis of the tongue, difficult deglutition and mastication 
as well as loosened teeth are met with in fracture of the 
hyoid bone, respectively maxillary bone. Fracture of the 
cervical vertebr£e may give rise to paralysis of the dia- 
phragm. Fracture of the cranial bones may be followed by 
paralysis of the brain. 

What points do you take into consideratioii in the diagnosis 
of incomplete fractures ? 

A positive diagnosis of these is not always possible, this 
referring especially to the so-called fissured fracture, quite 
commonly seen on the os suffraginis and tibia and less often, 
on the OS corona and vertebral column of the horse. 

The essential features upon which the diagnosis in these 
cases is based are: sudden intense supporting leg lameness 
(for detailed descriptions, see my " Clinical Diagnosis of 
Lameness in the Horse")? with a history of external violence. 
(This symptom does not hold good in cases of fissured ver- 
tebrae, where the horse sometimes works for days without 
showing any loss of function at all.) There is usually volar 
flexion of the phalanges, but no change in form or abnormal 
mobility of the parts. In one to two days after the accident 
there is more or less cedematous infiltration of the overlying^ 



DISEASES OP BONES 159 

soft tissues. Tlie individual disposition toward pain varies 
greatly in animals ; in some it is impossible to palpate the 
limb, while others hardly react. Twisting of the fissured 
bone and pressure upon certain parts produce more or less 
pain. Theoretically, there ought to be distinct pain along 
the line of fracture ; in practice this may occasionally be 
detected, but on the whole such fractures can only be diag- 
nosed by the train of symptoms and the history of the case 
and by a systematic and thorough examination for all those 
conditions which have symptoms similar to those of a frac- 
ture ; in other words, the condition can be forcibly surmised 
by a diagnosis by exclusion. 
What points are of importance in the prognosis of fractures ? 

1. Economic reasons. While a fracture may be curable, 
economic reasons may forbid the treatment. Therefore, in 
each case the first question is. Does it pay the owner to have 
this fracture treated? If not, the slaughter of the animal 
should be suggested. 

2. The animal species. In the horse and cattle, treatment 
of fractures is tedious, because it is often very difficult and 
sometimes impossible to adjust dressings to the broken ends 
of the bone which hold the fragments in place. Continuously 
resting upon three legs or the recumbent position may be 
complicated by laminitis (comparatively rare) or by decubitus 
and subsequent sepsis. Fractures in cattle and horses heal 
in about one to three months ; in the dog, in three to four 
weeks ; in birds, about fourteen days. 

3. The broken bone itself is of great importance. Thus, 
in the horse and cattle, fracture of the vertebrae with injury 
to the spinal cord, and, as a rule, both simple and complicated 
fractures of the femur, tibia, scapula, humerus and radius, 
certain pelvic fractures and comminuted fractures of the os 



160 PRINCIPLES OF VETERINARY SURGERY 

corona and suffraginis, are incurable. Fractures of the 
metacarpus and metatarsus stand a slightly better show. 
Finally, treatment may be attempted in fractures of the 
processes of the vertebrae, simple fracture of the os pedis, 
OS corona, suffraginis, ribs, external angle of the ilium, facial 
bones. 

4. The variety of fracture is equally important. Com- 
minuted and complicated fractures and those involving a 
joint or its neighborhood are, as a rule, not treated. Old 
fractures and those where marked displacement of the frag- 
ments is present are unfavorable, for this reason. Transverse 
fractures are more favorable than oblique ones. Simple 
fractures and fissures are more favorable than complete ones. 
Fractures near joints may lead to an anchylosis and therefore 
chronic lameness. 

5. The age of the animal is important, for economic 
reasons and also because the process of healing is much 
slower in old than in young animals. 

The prognosis of fractures, especially to the beginner, 
offers many difficulties. The following examples may be 
of some service to him : 

1. High-priced carriage horse (gelding), of good age, 
with fissure fracture of the os suffraginis. It will take from 
six to twelve weeks to heal the fracture. As the result of 
bony deposits along the fissure there are good chances for a 
chronic lameness, which may be relieved by neurectomy 
provided there are no articular complications. Inform the 
owner of these points and the approximate expense connected 
with the treatment of the animal. If you have yet to make 
a reputation, call on some brother practitioner of established 
reputation and business integrity to assist you ; then let the 
owner decide. 



DISEASES OF BONES 161 

2. Running liorse (stallion), good age ; oblique fracture 
of the metatarsus. Prognosis favorable for a cure, but 
animal will be unfit for the race track ; useful for breeding 
purposes only. If the owner is satisfied to use him in the 
stud, go ahead with your treatment. 

3. Trotting mare, due to foal in five days ; fracture of the 
shaft of the ilium. Perform Csesarean section and try to 
save the foal, because the mare is most likely doomed as a 
"breeder and may abort as the result of the accident. 

4. Cow, in calf four months ; fracture of the floor of the 
pelvis. If this cow is a fine butter or milk cow, let her 
finish her period of gestation, and then remove the calf by 
performing embryotomy. In this way the owner will have 
the use of that cow for another year, when she ought to be 
sold for fat beef. If the cow is but a common scrub and in 
the above condition, advise immediate slaughter. 

5. Pet dog ; comminuted fracture of the metatarsus. 
Owner wants the life of his favorite saved, no matter what 
the expense. Amputation below the tarsus most likely the 
only chance in this case. Try to impress the owner with the 
fact that a dog with three legs only is a burden to himself 
and all those about him. If he or she — it is usually a she — 
persists, operate. More than likely the animal will be at 
your office within a year or so to be chloroformed. 

6. Gelding, 13 years old ; a little sore in front ; splendid 
worker. While going to the blacksmith fell on his left hind 
leg ; got up quite lame ; was put back into the barn and a 
veterinarian called at once, who diagnosed a fracture of the 
femur, and advised to kill the animal. This horse being the 
first one the owner ever bought, he thinks a great deal of him 
and orders the barn man to feed "old Jim" one more good 
square supper and that he will have him shot in the morning. 



162 PBINCIPLES OF VETERINARY SURGERY 

lu tlie morning the barnman reports ''old Jim" eating well, 
very lame, and quite a swelling about the region of the hip, 
whereupon the owner concludes to call another veterinarian 
for an opinion and his choice falls upon you. The owner 
meets you, gives you the history of the case, most" likely 
omitting the diagnosis of your predecessor, and says : " If the 
leg of this horse is broken, I want to have him shot, as I 
don't want the old fellow to suffer any longer." Inspection 
simply shows a swelling in the region of the hip joint. This 
swelling is painful and hot. The leg is rested upon the toe, 
the horse drawing the leg up once in a while. Palpation from 
the stifle joint down is negative. Pulse, 48 ; respirations, 18. 
Mucous membranes slightly congested. Temperature, 101.2 
deg. F. When backed out of his stall he hops on three legs. 
The history of a fall followed by sudden severe lameness 
causes you to suspect a fracture. Now you palpate the pelvic 
bones per rectum, at the same time having his leg twisted, 
brought forward, backward and abducted. You imagine you 
perceive a faint crepitus. After finishing your examination, 
what can you honestly say ? What facts has your systematic 
and careful examination revealed ? The owner wants a posi- 
tive answer one way or the other. This is a case where 
nobody can positively diagnose a fracture ; there are simply 
some indications to that effect. Tell the owner that since the 
decisive symptoms of a fracture are wanting and your 
examination is greatly handicapped by the large swelling, it 
preventing you from making a close examination of the 
underlying parts, you suggest an antiphlogistic treatment — 
(don't use the latter term, because he would most likely not 
understand the word " antiphlogistic ") — for four to five 
days, at the end of which time you will re-examine the 
horse. 



DISEASES OF BONES 163 

HEALING OF FRACTURES. 

How do aseptic fractures heal 9 

The process of repair is closely related to the healing of 
an aseptic skin wound. The blood which has been effused 
as result of the injury is presently absorbed and has nothing 
to do with the process of repair. The periosteum and bone 
marrow and soft parts undergo an aseptic inflammation, 
exudation occurs, and a mass of embryonic tissue — that is, 
granulation tissue — is the result. This granulation tissue, at 
first soft, subsequently ossified, glues the fragments together, 
so to speak, and is termed the callus, and the bone once more 
becomes a solid structure. 

What varieties of callus are concerned in the healing of 
fractures f 

1. The external callus, developing from the bone-pro- 
ducing cells (osteoblasts) of the deeper layers of the 
periosteum. 

3. The internal callus, developing from the bone-pro- 
ducing cells (osteoblasts) of the marrow. 

3. The intermediate callus It lies between the fractured 
ends and is composed partly from the external, partly from 
the internal callus. 

What is a provisional callus ? 

The soft, spongy tissue at first forming around and be- 
tween the broken ends ; it is the result of the action of the 
osteoblasts. 

What is a permanent callus ? 

This is the provisional callus, having undergone ossifica- 
tion. In other words, it represents a bone scar formed 
mainly through the agency of the osteoclasts. 



164 PKINCIPLES OP VETERINAEY SURGERY 

What is the difference between the provisional and permanent 
callus ? 
Both are the same product of a process of regeneration, 
only in different stages of development. 

What are osteoclasts 9 

These are multinuclear giant cells supposed to have the 
power to form free carbon dioxide and thus dissolve the 
lime salts of the bones and absorb bony substance. 

What is a synosteosis 9 

The permanent union of two single parallel bones by a 
callus ; for instance, in fracture of two adjoining ribs. 

What is an anchylosis 9 

A stiff joint. Here the articulating extremities of two 
bones are rendered immovable by a callus. 

What is a fibrous callus 9 

One which, instead of being composed of bone, is made 
lip of fibrous tissue. In other words, the callus never reached 
a higher development than the fibrous stage. Seen in frac- 
tures of bones with limited blood supply, insufiQcient immo- 
bilization of the fragments and in those where the fragments 
were drawn apart to considerable extent : false ribs, patella, 
pisiform bone, olecranon, etc. 

What two processes is the ossification of the callus the result 
of 9 

It is the result of an ossifying periostitis and osteomye- 
litis. 
What is a pseudoarthrosis 9 

It represents an ununited fracture ; that is, the broken 
€nds show mobility, being held together by fibrous union ; 



DISEASES OF BONES 165' 

there may be a fibrous capsule, wbicli after some time may 
secrete a serous fluid for lubrication of the broken ends of the 
bone, which may be smooth and eburnated and possibly 
covered by hyaline cartilage, in this instance forming a new 
joint. 

Describe the process of ossification of a callus. 

The ossification of the granulation is either a direct or 
indirect one. The former is the result of direct ossification 
by the osteoblasts of the periosteal and myeloginous granula- 
tion tissue (the embryonic tissue following inflammation of 
the periosteum and marrow). In the indirect process of 
ossification of the granulation tissue, this latter first becomes 
cartilage, which in turn becomes bony tissue. About the 
third or fourth day after the fracture occurs, little foci of 
osteoid tissue exhibit themselves at the point of fracture (due 
to the action of osteoblasts). In the second week the external 
callus is still soft ; by the end of the third week the periosteal 
callus consists of pretty firm, spongy bone. The internal 
callus undergoes the same changes. 

In four to five weeks the provisional callus begins to 
be converted into a permanent cicatrix (permanent callus), 
the superficial and deeper portions of the provisional callus 
become absorbed — mainly by the action of the osteoclasts ; 
finally, the medullary cavity of the bone is more or less 
restored and the surface of the bone shows but little of the 
large ovoid mass, the original callus. 

How is the regular callus formation interfered ivith 9 

By constitutional diseases, as osteoporosis, osteomalacia, 
infectious diseases, by marked displacement of the bony frag- 
ments, infection of the tissues at the point of fracture, decided 
splintering of the bone ; by the lodging of soft tissues between 



166 PRINCIPLES OF VETERINARY SURGERY 

the broken ends, continuous mobility of the broken ends 
(insufficient immobilization) . 

Hoiv do complicated fractures heal ? 

The seriousness of a complicated fracture lies in the 
amount of splintering of the bone, and especially the age and 
amount of injury to the skin and neighboring soft parts. 
Complicated fractures where the skin wound can be asep- 
ticised heal almost as rapidly as a subcutaneous — that is, 
aseptic — fracture. 

In the complicated fracture the callus formation is the 
same as in the subcutaneous fracture, but is greatly inter- 
fered with as the result of those conditions which are sequels 
of an infection, namely : purulent cellulitis, retention of pus, 
lymphangitis, necrosis of the soft parts and bones, purulent 
periostitis and myelitis, formation of fistulse and general 
sepsis, as septicsemia and pyaemia. 

How would you testify in Court in a case of this sort f 

A horse was sold by A to B and warranted by A as 
sound and true in all harness. In the morning after the pur- 
chase the horse is down and unable to get up. You are 
called and diagnose complete fracture of the tibia and order 
the horse killed. Post-mortem examination reveals a soft 
external spongy callus at the line of fracture. Your certifi- 
cate therefore will state that the animal was unsound at the 
time of purchase suffering with a fissured fracture of about 
two weeks' standing. Had the fracture occurred during the 
night at the new owner's stable, there would be no osteoid 
tissue present, that is, no callus, but simply an effusion of 
blood and symptoms of a fresh aseptic inflammation. 

Hoiv do you treat simple fracture ? 

1. By reducing the fracture. This means that the sur- 



DISEASES OP BONES 167 

geoii restores the displaced fragments to their normal position 
or as close to it as possible 

2. By retaining the fragments in position. 

Hoiu is a fracture reduced ? 

1. By extension ; that is, the Surgeon exerts steady trac- 
tion upon the lower fragment. 

2. By counter-extension. This means the fixing of the 
upper fragment. 

3. By coaptation, by which is understood the adjustment 
of the fragments to their proper position. 

Why are these steps necessary ? 

Absolute rest to the broken bone and proper adjustment 
of the fragments are essential to the normal development of 
a callus. 

Can you reduce the fractures in all animals this way ? 

In the dog and other small animals, as a rule. The 
larger animals offer great difficulties. In such fractures as 
those of the pelvis and ribs, the reduction of a fracture by 
extension and counter-extension, etc., is out of the question; 
also when fragments of bone get between the ends when 
muscles are pinched in, when the broken bones can't be 
grasped or fixed. 

Why do you employ extension and counter-extension in 
reducing a fracture ? 
It is done to overcome the contraction of muscles and the 
elasticity of fascise, tendon, etc. 

How do you proceed for this purpose 9 

The smaller animals may be given a dose of morphine 
and are then laid upon a table, where, with the help of one 
or two assistants, the upper fragment is firmly held, while 



168 PRINCIPLES OF VETERINARY SURGERY 

anotlier person steadily pulls upon the lower fragment, as 
much as possible in the direction of the normal axis of the 
broken bone, while the surgeon adjusts the broken fragments 
to their proper j^osition. In the larger animals, chloroform 
is best. Given in the horse, morphine is contraindicated, as 
its after effects (the horse gets restless) are detrimental. Of 
course before the animal is laid down it will be necessary tO' 
temporarily dress the broken parts to avoid further injury as 
he is laid down. Sometimes extension, counter-extension and 
reduction can be effected simply with the aid of a nose-twist. 
In practicing extension in the horse it is at times necessary to 
make use of pulleys to overcome the resistance offered by the 
elasticity of muscles, tendons, etc. 

How can you tell that the limb is properly reduced ? 

Take into consideration the jjosition of the hoof or toes, 
as the case may be, and the length of the limb. 

Hoiu are the hrohen fragments retained in proper position ? 

In both horse and dog, I consider the plaster of paris 
bandage the best means. 

Hoiv do you apply the plaster of paris dressing ? 

Unless considerable swelling is present, a permanent 
dressing is applied as follows : Wrap around the affected 
part a thin layer of cotton ; place over it a flannel bandage 
and over this the plaster of paris dressing. In the horse it is 
not necessary to apply the first layer — that is, the cotton. 

How do you treat a recent simple fracture ivith considerable 

swelling of the adjacent soft parts ? 

Here a permanent dressing cannot be applied, therefore 

a temporary one should be used, consisting of padding the 

parts with cotton, placing over this a flannel bandage ; the 



DISEASES OF BONES 169 

"broken parts being besides this braced by stays or splints of 
binder's board, wood, or in tlie horse, band iron, snch as is 
nsed in barrel hoops, held in place by the flannel bandage. 
Such a part is now kept moist with evaporating lotions until 
the oedematous state has disappeared, enabling one to apx)ly a 
permanent dressing at the end of the third to the fifth day of 
such treatment. 

What precautions do you tahe in applying a plaster of parts 
dressing 9 

1. Apply the plaster bandage uniformly and not too 
tightly. 

2. Watch the skin and parts at the lower end of the 
plaster dressing for any swelling ; when this shows — in other 
words, when oedema of the lower parts occurs — ease the dress- 
ing, in case of a temporary one, or remove it and apply a new 
one in case of a permanent dressing. 

3. In dogs, it is essential to apply a cotton padding to all 
projecting parts to be covered with the plaster dressing, as 
the pressure continuously applied to the skin by the dressing 
would lead to gangrene and constitutional disturbances. 
Should necrosis of the skin really set in, treat the parts anti- 
septically. 

4. Immobilization of the fractured bone being a requisite,, 
envelop the joints above and below the point of fracture with 
the dressing wherever possible. The shape of certain parts 
renders it very difficult to securely apply a plaster dressing, 
as, for instance, in the forearm or thigh, the dressing here 
having a tendency to slip down ; in these instances, run the 
plaster bandage over the back, forming a saddle, so to speak^ 
this latter holding the dressing in place, preventing it from 
slipping. 



170 PEINCIPLES OP VETERINARY SURGERY 

What other precautions are necessary to secure healing of a 
fracture 9 

Keep the animal quiet. Put the horse into a narrow 
stall and in slings, provided these do not irritate him. It is 
sometimes wonderful how a colt or horse, when turned into a 
box stall after his leg is properly set, will nurse it. The 
judgment of the surgeon is decisive here. 

Hoiv soon can you remove the permanent plaster of paris 
dressing 9 

In the horse, in six to twelve weeks ; in the dog, in about 
four weeks ; and in birds, about fourteen days. 

Hou) can you encourage callus formation hy internal medica- 
tion 9 
Give horses once daily one-quarter to one-half grain of 
phosphorus ; the dog, 1-200 to 1-100 grain. 

If you throw a horse for an operation and he hreaks a hone at 

the tim^e, what prophylactic steps must you take previous 

to throwing him and ivhile throiving him to escape a 

verdict of guilty in case the owner of such a horse sues 

you for damages 9 

Three classes of horses demand our attention here : the 

highly -bred horse (runners, trotters, etc.), the highly-fed 

draft horse and the old horse. The first two are likely to 

fight and wriggle around viciously as soon as they are laid 

down, subjecting themselves to fractures and a struggling 

myositis ; the last one — that is, the old horse — is predisposed 

to fractures of the vertebrte by reason of ankylosis and senile 

atrophy of the vertebral bones. 

Whenever possible, operate the old horse in the standing 
posture and only lay him down when absolutely necessary. 



DISEASES OF BONES 171 

The following plan, of course altered according to cir- 
cumstances, has given me splendid results : 

The horse which is to be laid down is given an aloetic 
purge, provding that his condition permits it. The day he 
enters or when at the home of the owner he is given a liberal 
water diet and fed a moderate amount of bran mash and no 
hay. The second day he is given an armful of hay in the 
morning and one bran mash in the evening ; as a rule, they 
do not care to eat very much anyway on account of the 
aloetic purge. On the third day he is operated, not getting 
any food but a little water when to be operated in the morn- 
ing, or a bran mash for breakfast and some water at dinner 
when to be operated in the afternoon or evening. Of course 
modifications must be made to meet the various conditions 
of the patient and of the surgeon's practice. 

The animal is to be thrown upon a soft bed and in a 
place affording sufficient space and light. The throwing 
harness should have a belly-band and a halter, by means of 
which the animal's head can be checked up sufficiently to 
prevent undue curving of the spine. In other words, the 
head and neck ought to be stretched out nicely when it is 
down. Undue lateral motions with the haunches and head 
are overcome by having someone hold the head properly and 
someone sitting upon the hip region. In case of all painful 
and prolonged operations the animals must be chloroformed, 
otherwise local anaesthesia is indicated. 

Will such precautions relieve the surgeon of all responsibility? 

Fractures will occur even under these circumstances, as 
experience teaches that the throwing of horses is not without 
danger to the animal. 



172 PKINCIPLES OF VETEEINART SUEGERY 

How do you treat complicated fractures 9 

Formerly compound fractures necessarily were looked 
upon as exceedingly dangerous accidents, but antiseptic 
surgery has taught us how to disinfect a wound and thus. 
reduce septic dangers to a minimum. The treatment of com- 
pound fractures differs radically from that of a simple or- 
subcutaneous fracture, by reason of the fact that the former- 
is complicated by a wound and therefore exposed to septia 
sequels. The sine qua non in the treatment of a compound 
fracture is exhaustive disinfection of the wound of the soft 
parts and drainage when necessary. 

1. "When the wound of the integument is small and clean^ 
disinfect it ; set the fracture, apply an antiseptic dressing ta 
"wound and over it place the plaster of paris bandage. 

2. When the fracture is complicated with decided lacera-^ 
tion of the soft parts, bony fragments perforating the skin or 
a joint open, disinfect every nook and corner of the wound, 
trim the sharp points of the bony fragments, ligate bleeding^ 
vessels, cut away contused tissues, remove foreign bodies, etc. ;. 
make counter-openings for drainage, arrange the bony frag- 
ments, suture the cutaneous wound as far as possible, pre-^ 
viously tamponing the wound cavity with iodoform gauze, 
and apply a temporary dressing, changing it at regular inter- 
vals. The plaster of paris bandage in these cases is to be 
applied as soon as the wound is healed. 

3. Fractures with septic infection — that is, those older- 
than one or two days — are also " purified '* and best treated 
by continuous irrigation, applying such a temporary dressing- 
as will permit of limited disturbance of the bony fragments. 

4. Fractures "where the parts are simply ground to pieces.. 
or those where the dangers of a general infection is marked. 
Thorough disinfection is to be tried, and when insufficient^ 



DISEASES OF BONES 173 

as a last resource, amputation of the affected parts is neces- 
sary. 

When are the above principles applicable in veterinary 
surgery ? 

The veterinarian is occasionally called upon to extend 
such treatment to pet dogs, or larger animals which on 
account of their value as producers are worth the expense of 
such a treatment. 

Which fractures in the horse are of special interest to the 
practitioner ? 

1. Fracture of the external angle of the ilium. Inspec- 
tion : Rounded appearance of that portion of the pelvis, 
swinging-leg lameness. Palpation : No crepitation, and 
absence of external angle of ilium, as the hony fragment is 
drawn down and inwards. Prognosis favorable. Time re- 
quired, four to six weeks. 

2. Fracture of the shaft of the ilium. Inspection : 
Swinging-leg lameness, possibly swelling of that half of the 
pelvis. Palpation : Crepitation, usually by rectal examina- 
tion or by placing one hand over the region of the hip and 
the other one against the ischial tuberosity and causing the 
liorse to step over. Prognosis doubtful. 

3. Fracture through the obturator foramen. Inspection : 
Supporting-leg lameness. Palpation : Crepitation on rectal 
examination. Prognosis doubtful. 

4. Fracture of the pubis. Inspection : Supporting-leg 
lameness, possibly swelling under the belly (scrotum, udder). 
Palpation : Crepitation, not always detectable. Prognosis 
doubtful. 

5. Fracture of external branch of the ischium. Inspec- 
tion : Little or no lameness, region of hip joint bulges out. 



174 PEINCIPLES OP VETERINARY SURGERY 

Palpation : Crepitation, usually pronounced. Prognosis 
doubtful. 

6. Fracture of the tuberosity of tlie ischium. Inspection: 
Swinging-leg lameness ; before swelling sets in, the affected 
region appears broader, later there is swelling, involving- 
rectum and vagina. Palpation : Crepitation more or less 
marked. Prognosis doubtful. 

7. Fracture in the cotyloid cavity. Fractures through or 
close to the symphysis pubis almost invariably demand an 
unfavorable prognosis (for details, see my work on ''The 
Clinical Diagnosis of Lameness in the Horse '"). 

8. Fracture of the os suffraginis. Due to jumping and 
missteps, sudden turning, slipping, etc., the fracture may be 
a comx^lete or, as is quite frequently the case, only a fissured 
one. Inspection: Supporting-leg lameness, possibly deform- 
ity and abnormal mobility. Fissured fractures, while caus- 
ing severe lameness, still permit the animal to support some 
weight. Palpation : More or less crepitation and abnormal 
mobility; artificial rotation produces great pain. In fissured 
fractures, palpation along the extensor pedis tendon may 
elicit a painful line, switching off to one side or the 
other (usually the outer one). Prognosis : In complete 
fractures, doubtful ; in fissured fractures, healing with a 
plaster of paris dressing may occur in six to eight 
weeks. 

9. Fracture of the os corona ; fracture of the os pedis. 
The same rules, generally speaking, apply to those as given, 
under fracture of the os suffraginis. 

10. Fracture of the femur. Due to falls, drawing the 
hind leg up as high as the elbow when tying the animal for 
operations. Lameness is severe. Crepitation usually well 
marked, also abnormal mobility. Prognosis is unfavorable^ 



DISEASES OF BONES 175 

■unless it be simply a fracture of the trochanter, when it is 
favorable. 

11. Fracture of the tibia. Often the consequence of kicks 
upon the internal aspect of the limb ; it may follow also 
a fissured state of the bone, a complete fracture being the 
result of the lying down and rising or working of the animal. 
The symptoms of a complicated fracture are most common. 
Crepitation and abnormal mobility. Fissured fractures are 
difficult to diagnose ; when there is good reason to suspect 
one, treat as such. , 

12. Fracture of the vertebral column. May follow a 
previous fissured state or occurs when down and unable to 
get up, as the result of excessive action of the ileo psoas and 
longissimus dorsi (excessive upward curving of the back) or 
from excessive bending of one side only. As a result of the 
injury to the spinal cord by the fractured bone, paralysis sets 
in, the animal is unable to rise and does not react to needle 
pricks. When happening during an operation, a peculiar 
crunching sound is heard ; otherwise I have never been able 
to detect crepitation or abnormal mobility. Prognosis is 
unfavorable. 

13. Fracture of the ribs. Due to blows of some sort. 
Those following kicks are often complicated fractures. In- 
spection may reveal a depression or swelling. Palpation : 
Pain ; crepitation is rarely detected, but a crackling sensa- 
tion, due to subcutaneous emphysema, may be observed. 
Pleurisy, pneumonia, pneumothorax, etc., are likely to follow 
perforating fractures. Prognosis : In simple fractures, which 
are often only surmised, it is favorable, and four to six weeks' 
rest are sufficient ; in complicated fractures it is at times 
doubtful, and when not followed by death, fistula of the ribs 
may remain. 



176 PKINCIPLES OP VETERINARY SURGERY 

14. Fracture of tlie inferior maxilla. Of doubtful prog- 
nosis are transverse fractures of the brandies of the bone, 
mainly characterized by more or less crepitation, abnormal 
mobility, swelling, disturbed mastication. Fractures through, 
the union of the branches at their inferior extremity usually 
heal in one month. 

Describe the most important fractures in the dog. 

1. Fracture of the scapula. Follows falls and being run 
over. Parts most frequently involved are the neck and 
coracoid process. Prognosis is favorable. 

2. Fracture of the humerus. Usually involves lower 
third of bone. The prognosis of subcutaneous fractures is 
usually a favorable one. The plaster of paris bandage, in this 
as well as in fracture of the scapula, should be run around 
the chest and over the back like a saddle to prevent slipping 
and to immobilize the parts properly. 

3. Fracture of the radius and ulna. In most cases both, 
bones fracture at the same time and mostly at the lower 
third. In solitary fractures of the ulna the olecranon is 
usually the part that breaks. Unless the fracture is badly 
complicated, the prognosis is favorable. While not abso- 
lutely necessary, I prefer to saddle the back with the plaster 
of paris bandage in these cases. 

4. Fracture of the carpus is usually a simple one and has 
a favorable prognosis. 

5. Fracture of the metacarpal bones occurs usually at the 
middle or lower third. Unless seriously complicated, they 
have a favorable prognosis. 

6. Fracture of the phalanges. These are usually com- 
plicated, being mostly the result of the animal being run over. 
Prognosis even here is good, as the smashed toe is easily re- 
amputated, not interfering with the animal's usefulness. 



DISEASES OF BONES 177 

6. Fracture of tlie pelvic bones. The most common 
cause consists in being run over, also kicks, falls, etc. The 
shaft of the ilium, its external angle and region of the coty- 
loid cavity are quite frequent, while of course the other pelvic 
bones are also, but less commonly, found fractured. There 
may be paralysis as well as the other symptoms peculiar to 
fractures. Prognosis is doubtful or unfavorable. 

8. Fracture of the femur. This fracture heals less kindly, 
it being difficult to immobilize the parts, requiring at least 
four weeks. Most fractures occur at the lower third, next 
comes the upper third and finally the middle third of the 
bone. 

9. Fracture of the tibia and fibula. This one has a more 
favorable prognosis than that of the femur. The part in- 
volved is usually the lower third of the bone. 

10. Fracture of the tarsus, metacarpus and phalanges. 
The metatarsus usually breaks in the upper and middle third; 
the tarsus is less often fractured, while the i^halanges exhibit 
m.ostly a complicated fracture. In these, the same rules hold 
good as in the corresponding bones of the forelegs. 

11. Fracture of the inferior maxilla. This one, as well as 
fractures of the bones of the head, is quite rare. The frac- 
tures of the inferior maxillary bones more commonly are 
found at the union of the inferior extremity of the branches 
(prognosis favorable); further, in the region of the canine 
tooth. Transverse fractures of this locality are often difficult 
to treat and may require excision of the bony fragment. 

12. Fracture of the vertebral column. These are, on the 
whole, seldom encountered excepting those of the coccygeal 
vertebrse, the treatment of which consists in amputation of 
that part of the tail. Being almost invariably the result of 
"being run over, or getting pinched in between a door, the 



178 PRINCIPLES OP VETERINARY SURGERY 

cervical and lumbar vertebrae are those most exposed to 
fractures, wbicli, leading to paralysis, leave no hope for a 
successful treatment. 

13. Fracture of the ribs. Usually more than one rib is 
broken. A favorable prognosis can be offered unless such 
complications as pleurisy or pneumonia are present or to be 
expected. This fracture exceeds 'in frequency those of the 
vertebral column. 

14. Fracture of the sternum. Seems to be exceedingly 
rare. 

Inflammation of Bone. 

From a practical standpoint, which are the most important 
structures involved in bony inflammations 9 

The most important is the periosteum in animals ; next, 
the osseous tissue proper ; finally, the marrow. 

How do you term inflammation of the periosteum, bony sub- 
stance and marrow ? 
Periostitis, osteitis, osteomyelitis. 

Do inflammatory processes of bones differ materially from 
those of soft parts ? 

They do not, since the osseous tissue exhibits no material 
difference from the soft parts, practically speaking, being 
soft parts rendered firm by the addition of lime salts. For 
this reason injuries and diseases of bones are, on the whole, 
of like character and run about the same course as similar 
injuries and diseases of soft tissues. 

Depending on the course of the disease, lohat variety of inflam- 
mations are considered in bony inflammations f 
These inflammations run either an acute or chronic 
course. 



DISEASES OF BONES 179 

Depending on the cause of the disease, luJiat variety of inflam- 
mations are considered in hony inflammations 9 
The causes may be traumatic (due to external assaults), 
specific (as tuberculous, glanderous, etc.), hematogenous 
(originating in the blood), septic and aseptic, primary and 
secondary. 

Periostitis. 

What is periostitis ? 

Inflammation of the highly nervous and vascular fibrous 
membrane covering the bone, termed j)eriosteum. 

What forms of periostitis are of interest to the surgeon ? 

1. Acute, aseptic or traumatic periostitis. 

2. Chronic ossifying periostitis. 

3. Acute purulent periostitis. 
■4. Chronic purulent periostitis. 
5. Chronic fibrous periostitis. 

Describe acute aseptic periostitis. 

This form of j)eriostitis is the result of contusions, blows, 
as kicks, interfering, pressure from the bit upon the inter- 
dental space, or is seen as a consequence of simple subcu- 
taneous fracture, and, as the name indicates, runs its course 
without the presence of pus producing bacteria in the affected 
tissues. 
What are the symptoms of acute aseptic periostitis ? 

The periosteum being highly endowed with nerves, pal- 
pation elicits decided pain and circumscribed doughy swell- 
ing. When affecting bones of the extremities, there is 
lameness, or when involving the interdental space of the 
lower jaw, the animal will not tolerate the bit, is more or less 
head shy, etc. 



180 PRINCIPLES OF VETERINARY SURGERY 

How do you treat these cases ? 

Rest to the parts ; when possible, warm moist applica- 
tions, blisters. 

Describe chronic ossifying periostitis. 

In this form the products of inflammation become ossi- 
£ed, showing that the inflammatory process mainly involves 
the deeper layer of the periosteum — that is, the osteogenous 
layer inhabited by the osteoblasts ; the form is a sequel of 
acute asej)tic periostitis playing such an important role in the 
■callus formation of a simple fracture. 

What are the causes of chronic ossifying periostitis ? 
Repeated traumatic irritation of the periosteum. 

What are the symptoms of this form of p)eriostitis ? 

In due time a bony growth appears, variously known as 
■osteophyte, exostosis ; previous to the full development of 
this bony deposit there is pain on palj^ation, more or less 
doughy swelling, possibly lameness, etc. 

Which hones most commorily imdergo chronic ossifying 
periostitis ? 
The bone most commonly affected is the metacarpus of 
the horse ; here the exostosis is termed a splint and appears 
almost invariably between the small and large metacarpal 
bones on the internal face of the shin bone ; the exostosis 
about the tarsus is known as spavin. Animals with certain 
malpositions of the limbs are predisposed to a chronic ossify- 
ing periostitis, leading to a bony growth termed a " periar- 
ticular ringbone." In these cases the periosteum is con- 
tinuously irritated by being tugged upon by the ligaments of 
the joint, the result of the faulty position of the hoof. A 
similar explanation holds good in splint formations. In 



DISEASES OF BONES 18L 

chronic alveolar periostitis the tooth becomes united to the 
alveolar wall, rendering extraction at times very difficult. 
In horses suffering with chronic bursitis intertubercularis, 
bony deposits upon the humerus are found. 

How do you treat ossifying periostitis 9 

By blisters and the actual cautery, and when they fail,, 
by neurectomy. 

Describe acute purident periostitis. 

In this form, pus-producing bacteria enter the periosteum 
from without — that is, through a wound of the overlying 
soft parts, as, for instance, in complicated fractures ; or the 
bacteria reach the periosteum from within, as in purulent 
myelitis ; or the infectious agent gets to the periosteum 
through the blood current, the periosteum in such a case 
representing a secondary or metastatic focus. 

How do you treat these cases ? 

By incision and antiseptic irrigations and dressings. 
What is a subperiosteal abscess 9 

An abscess formed under the periosteum, the result of a 
j)urulent infection of the marrow (purulent osteomyelitis). 
Its treatment consists of incising the abscess and antiseptic 
injections. 

Describe chronic purulent periostitis. 

In complicated fractures this form of periostitis, a sequel 
to acute purulent periostitis, is quite frequently seen, there- 
fore, in complicated fractures of the ribs, pelvis, etc., as also 
in injuries to the interdental space by pressure from severe 
bits and curbing, in alveolar periostitis. Fistulous tracts are 
the consequence, because this form of periostitis leads to 
necrosis of bone and as the result of this to fistulous states, 



182 PRINCIPLES OF VETERINARY SURGERY 

the dead piece of bone keeping up the irritation and thus 
furnishing active material for a purulent discharge. 

How do you treat chronic purulent periostitis ? 

This depends on the parts involved. Thus, in alveolar 
periostitis with empyema of the maxillary sinus, the sinus is 
trephined and the offending tooth removed. In other in- 
stances an incision is made down upon the diseased structures 
and the necrotic bit of bone removed by curetting, etc. 

Describe chronic fibrous periostitis. 

In this form a fibrous callus is formed, which by its 
pressure leads to atrophy of the underlying bone. In this 
instance the inflammation involves the upper layer of the 
periosteum, which, not being equipped with osteoblasts, can 
not ossify the products of inflammation, being a chronic 
connective tissue proliferation pure and simple. Its most 
common seat is right on top of the nasal bones, the result 
of pressure from the noseband of the bridle. 

Inflammation of the Osseous Tissue. 

Which histological structures does infiammation of the osseous 
tissue involve 9 
The Haversian canals, spaces and canaliculi. 

What course does osteitis usually take 9 
Almost invariably a chronic course. 

What are the causes of osteitis 9 

The most frequent causes are pressure and contusions ; 
specific ones, as tuberculosis, actinomycosis, complicated 
fractures, the extension of inflammation from some other 
structure : for instance, from the marrow or periosteum. 



DISEASES OF BONES 183 

What forms of osteitis are of interest to the surgeon 9 

(1) Rarefying osteitis, (2) ossifying osteitis, (3) fungous 
osteitis, (4) deforming osteitis. 

Describe rarefying osteitis. 

This form of osseous inflammation is also known as 
osteoporosis. It is a degenerative osteitis, and usually the 
result of intensive or infectious processes ; it may exist alone 
or in combination with ossifying osteitis — that is, certain 
centers may exhibit a rarefying osteitis while the adjacent 
bony tissue undergoes an ossifying osteitis. Rarefying 
osteitis serves also to limit infectious processes, and further, 
to expel necrotic bone. 

Describe the changes taking place in the osseous tissue in 
rarefying osteitis. 
Following the inflammation there is an exudate. This 
exudate enters the Haversian canal, sj)aces and canaliculi; 
proliferation of the cellular elements takes place and thus 
embryonic tissue formation. As the result of the action of 
the osteoclasts, the bone undergoes rarefaction — that is, 
thinning ; granulation tissue becomes more and more abund- 
ant, gradually taking the place from which the bony sub- 
stance has been removed by the osteoclasts. The solution 
and removal of the bone does not occur uniformly, but 
irregularly here and there. 

Describe ossifying osteitis. 

This form of bony inflammation is also known as osteo- 
sclerosis. It is the opposite of rarefying osteitis, as it repre- 
sents a regenerative process and is usually the result of 
slighter and continuous — that is, chronic — irritations. Ossi- 
fying osteitis serves to render denser and stronger bony tissue 



184 PRINCIPLES OF VETERINARY SURGERY 

wliich has been weakened by previous disease. Tlie inflam- 
matory process being ratlier sluggish, a process closely 
resembling physiological bone-growth is observed. It starts 
mainly from the Haversian canals, these becoming narrower 
and consequently the bone denser and stronger. 

Name examples of ossifying osteitis. 

It is seen in the development of the spavin, in the final 
changes of the callus of a fracture. 

Describe fu7igous osteitis. 

This accompanies specific diseases, such as tuberculosis, 
glanders. Tuberculosis of bones is of hematogenous origin. 
The infected granulations are exuberant, often being of a 
fungoid nature. Osteomyelitis and caries are always present. 

Describe deforming osteitis. 

This represents a chronic inflammatory process, leading 
to an unnatural form or shajDe of the bone involved, due to 
softening, hypertrophy, etc. 

Give an exam]Dle of deforming osteitis. 
The spavin. 

Osteomyelitis. 

What forms of osteomyelitis are to be considered ? 

Ossifying and purulent myelitis. 
Wliere is ossifying osteomyelitis seen ? 

In fractures. 
Wlien is purulent osteomyelitis seen ? 

In complicated fractures and infectious diseases, as in 
tuberculosis, for instance, or when pus-producing bacteria^ 
invade the bone marrow. In these two instances it is of 



DISEASES OP BONES 185 

hematogenous origin ; that is, tlie infectious agents are 
hrouglit to the marrow by the blood current. 

Which form of osteomyelitis is the more common one ? 
Purulent osteomyelitis. 

Describe the changes taking place in osteomyelitis. 

At first the marrow appears dark red, due to hyperemia ; 
this is followed by absorption of the fat cells of the 
marrow, thus changing the yellow marrow into the juvenile 
or red marrow, which either organizes into bone tissue, filling 
the medullary canal as in callus formation of fractures, or 
when infected undergoes suppuration. In this case the 
adjoining bone tissue becomes involved and a rarefying 
osteitis is the result. As soon as the infectious material 
reaches the periosteum it is irritated by the infectious agent 
and an ossifying periostitis with subsequent exostosis follows, 
to be destroyed by the rarefying osteitis. As a result of this 
the ossifying periostitis becomes a purulent periostitis, the 
neighboring soft parts become infected, an infectious cellulitis 
ensues, and the pus thus eventually reaches the external 
world. 

Give exam^ples of purulent osteomyelitis. 

It is seen in the inderdental spaces of the horse as the 
result of pressure from severe bits in pullers ; also in connec- 
tion with alveolar periostitis in diseases of the teeth. 

Necrosis of Bones. 

What is necrosis of hones ? 

Death of the whole bone or part of the bone. 



186 PRINCIPLES OF VETEEINAEY SURGERY 

Name the causes of hone necrosis. 

It is usually the result of a disturbed circulation of the 
"blood caused by (1) traumatism, (2) inflammation. 

Hoiu do traumatisms produce necrosis ? 

Suppose that an animal is kicked and a complicated frac- 
ture the result. Bony splinters in such a fracture are no 
longer supplied with nutriment, as their blood supply is inter- 
rupted. Being a complicated fracture — that is, one infected 
by pus-producing bacteria — these bony fragments become 
necrotic. In subcutaneous bone wounds, or, for that matter, 
bone wounds which are not infected — that is, in an aseptic 
state — small bone splinters will be absorbed. 

How does inflammation produce necrosis ? 

Most commonly necrosis follows infectious inflammatory 
processes which may either arise in the bone or invade it 
from adjoining tissues. The former, for instance, are repre- 
sented by purulent periostitis and osteomyelitis as seen in the 
inderdental sj^aces of horses bitted severely or inclined to 
pull, or in the latter it reaches the bone by continuity ; for 
instance, in severe inflammation of the pododerm the os pedis 
— that is, a portion of it — may undergo necrosis. In severe 
phlegmonous states of the muscles and fascise overlying the 
dorsal vertebrae, as is seen in fistulous withers, some parts of 
the vertebrae may undergo necrosis, etc. 

What do you understand hy caries ? 

The slow death of a part of a bone with softening, solution 
and partial absorption of the same, almost invariably due to 
specific infections, especially tubercular osteomyelitis and 
osteitis. It is a form of necrosis. 



DISEASES OF BONES 187 

What do you understand by necrotic caries 9 

The separation or expulsion of dead bony fragments of a 
carious bone. 

What is dental caries 9 

Seen at times in the molar teeth of the horse, it represents 
a progressive destruction of the dentine and cement of such a 
tooth. 

Sow is dental caries produced 9 

When the enamel of the tooth is injured, destructive 
agents (bacteria, decomposing food) enter and exert their per- 
nicious influence upon the dentine and cement substance. 

Is there any difference hetiveen dental caries and alveolar 

periostitis 9 

Decidedly. They are two entirely different pathological 
processes, as dental caries may eventually lead to alveolar 
periostitis, but alveolar periostitis can never produce dental 
I caries, at least in the sense in which caries is here, according 
to modern views, employed. Dental caries usually starts at 
the crown of the tooth, working upward toward the root, 
"while alveolar periostitis begins at the periosteum of the 
alveolar cavity and root of the tooth. 

£>o all aidhors accept the above definitions of necrosis and 
caries 9 

Most modern authors on pathology recognize the above 
definition as compatible with progressive medicine, while 
some authors yet understand by necrosis destruction of bone 
in mass, while by caries is understood by them molecular death 
of bone. 



188 PKINCIPLES OF TETEEINARY SURGERY 

Why is the definition of caries, ^'Molecular death of honey** 
incorrect 9 
According to recognized teachings of to-day the cell is tli& 
unit of life and not the molecule. Consequently, it is only a. 
cell or a group of cells which can die, and not the molecule. 
Of course by the misnomer " molecular death '^ those employ- 
ing this faulty combination mean to say that death of a small 
portion of an orgar) has taken place. 

Wliat forms of necrosis are of practical interest ? 
(1) Superficial, (2) deep. 

What is a sequestrum ? \ 

A piece of dead bone surrounded by living tissue. 

Describe the process of sequestration in deep necrosis. 

A necrotic piece of bone is a foreign body and thus acts 
as an irritant to the adjacent tissues, in this instance healthy 
osseous tissue surrounding it. Necrosis of bone and gangrene- 
of soft tissues are analogous; in a similar way as soft gangren- 
; ous tissues are cast off soft healthy tissues by a line of granu- 
lations, the so-called line of demarcation, a line of granulation; 
springs up around and close to the necrosed bit of bone as the 
result of a granular osteitis. Now the salutory effect of a 
rarefying osteitis makes itself felt by dissolving and loosen- 
ing the dead piece of bone from the healthy bone, giving the. 
necrotic piece at the same time a worm-eaten appearance upon 
its surface ; while this is going on an ossifying periostitis and 
osteomyelitis develop around the site occupied by the dead 
piece of bone. Consequently new bone in the shape of an 
envelope forms, encasing the loosened piece of necrosed bone. 
This bony case containing the sequestrum and, of course, pus, 
is termed involucrum. This involucrum now is attacked by 



DISEASES OF BONES 189 

tlie rarefying osteitis, which destroys it here and there, mak- 
ing openings into it through which the pus and sequestrum 
may be gotten rid of. The openings in the involucrum, the 
result of the rarefying osteitis, are termed cloacae. In time 
the soft tissues surrounding the sequestrum may undergo 
gangrenous changes and the pus and bony fragments reach. 
thb external world at the point of least resistance, at which, 
moment a fistula is established. 

What is an exfoliation ? 

A superficially located sequestrum, the result of a super- 
ficial necrosis. 

Sow do you treat hone necrosis 9 

The essential feature consists in the removal of the 
necrotic fragment. For this purpose the chisel, the curette 
or the trephine may have to be employed. As a rule, caustic 
injections and even the actual cautery are less desirable. 

Atrophy of Bone. 

What is atrophy of bone f 

A decrease in size of the bone without change in its 
osseous structure. 

What forms of bone atrophy are recognized ? 

1. Concentric : The thinning progresses from without to 
Tsrithin, as a result of which the diameter of the shaft becomes 
lessened. 

2. Excentric : The thinning progresses from within to 
"without. 

Give examples of atrophy of bones. 

In sheep the cranial bones may become thin as paper as 
the result of the pressure upon the bone by the coenurus cere- 



190 PRINCIPLES OP VETERINARY SURGERY 

"bralis; by pressure from keraphyllocele upon the os pedis the 
latter wastes. The pressure of an aneurism against the verte- 
bral column produces thinning of the latter, etc. 

In chronic lameness, such as from spavin or ringbone, not 
only wasting of certain muscles sets in, but also an inactivity 
atrophy of the metacarpus or metatarsus. 

Senile atrophy of bones leads to fractures of the vertebral 
column when aged horses are thrown for operations. 

In such diseases as actinomycosis and osteoporosis, osteo- 
malacia, etc., an inflammatory atrophy is seen as a sequel to 
a rarefying osteitis, the atrophic changes being the result of 
the action of the osteoclasts. 

Hypertrophy of Bone. 

What do you understand hy hypertrophy of hone ? 

An increase in size of the bone without change in the 
osseous structure. 

What forms of hone hypertrophy are recognized ? 

1. Exostosis : It represents a circumscribed hypertrophy. 
This neoformation has no sharply defined boundaries, but 
gradually merges into the osseous tissue from which it springs. 

2. Osteophyte : Also represents a circumscribed hyper- 
trophy, being just as much the product of an ossifying- 
periostitis as the exostosis, but its boundaries are sharply 
defined and the osteophyte makes the impression as if it could 
be readily separated from the bone from which it springs. 

3. Hyperostosis : Represents a diffused hypertrophy ; in 
other words, a larger bone area is involved in the hypertrophic 
change. 

4. Osteosclerosis : Represents a hypertrophy arising in the 
marrow of the bone, while those previously spoken of origi- 
nate in the periosteum. I, 



DISEASES OF BONES 191 

What is Leontiasis ossea 9 

This represents a congenital hypertropliy where the facial 
and cranial bones are hypertrophied. Seen in horses (so-called 
bull heads) and in dogs. 

Rachitis (Rickets). 

What is rachitis ? 

A constitutional disease, primarily characterized by soft- 
ening and distortion of the bones of young animals. 

What are the causes ? 

They are obscure. Some authors claim a specific infec- 
tion ; others heredity, unhygienic conditions, a deficiency of 
earthy salts in the food, etc. 

Describe the changes taking place in the rachitic hone. 

There is chronic hyperemia of all the bone-forming tis- 
sues. The periosteum thus exhibits thickening in the bone- 
forming layer, giving the bone a thick and heavy appearance. 
The tissue proliferation arises in the osteogenous layer of the 
periosteum, remains soft for a long time and is late to calcify. 
The insertion of muscles are the best places to observe these 
periosteal proliferations. An insufficient amount of lime 
salts in the excessively developed cartilage at the epiphyseal 
line, as well as the indiscriminate distribution among one 
another of medullary tissue bone and cartilage, is a peculiarity. 
These changes do not confine themselves to the epiphyseal 
line, but may render the shaft of the bone distorted and soft 
that it may be cut with a knife. 

What are the characteristics of a rachitic hone ? 

Abnormal development at the epiphysis near articulating 
surfaces, distortion of the long bones and vertebral column, 



192 PRINCIPLES OP VETERINARY SURGERY 

bones of the head, a row of beaded enlargements at the union 
of ribs and costal cartilage, etc. 

What symptoms does the living rachitic anivoal exhibit 9 

The animals more commonly exhibiting this disease are 
swine ; next dogs, birds, and more rarely the colt and calf. 
The creatures appear poorly nourished, they walk stiffly, may 
stagger and tire easily. The knee, hock, stifle, fetlock may be 
swollen and is tender on pressure. 

How do you treat rachitis 9 

Establish hygienic conditions by changing food, stabling, 
etc. Prescribe a tonic treatment and phosphorus; horse, from 
-J to 2 grains ; dog, 1-20 to 1-120 grain. 

Osteomalacia. 

What is osteomalacia ? 

A constitutional disease of grown animals, characterized 
by softening and fragility of the bones. 

What animals are most exposed to it ? 

Mainly cows yielding a great deal of milk. 

What are the causes of osteo^malacia ? 

They are obscure. It is met with on high and low lands 
when fed the best of food or when succulent and watery on 
calcareous soils and those deficient in lime. The three theories 
as to its nature at this day are : 

1. A process of decalcification of the bones pure and 
simple. 

2. A chronic inflammation of the bone. 

3. Infectious disease. 



DISEASES OF BONES 193 

Describe the changes in an osteomalitic hone. 

The pelvic bones and those of the limbs are of special 
interest. In the beginning, there is simply hyperemia of 
the affected bone, small hemorrhagic foci being noticeable on. 
section of the bone. As the disease jifrogresses the hyperemia 
state becomes marked, the bone on section exhibiting bloody 
extravasation in the marrow and red punctation on the bone. 
When the disease advances yet more the bone becomes soft. 
The bone cells are replaced by fat cells. In short, the bone 
tissue degenerates until it becomes medullary tissue; the latter, 
increasing in bulk, becomes fatty, taking the place of bone 
tissue proper. 

Outline the symptoms of osteomalacia in the living animal. 

Perverted appetite, general depraved appearance. The 
creatures lie down a great deal, they are hide bound, the ani- 
mals walk stiffly. In well advanced cases, fractures, distor- 
tions of the bones of the pelvis and legs are common. 

Hoiv do you treat osteomalacia ? 

Change the diet to one rich in lime, give phosphorus with 
oil in doses of from 2 to 3 grains for cattle. In man the 
removal of the ovaries and testicles has given splendid results 
in the treatment of osteomalacia. 

Osteoporosis of the Horse. 

What is osteoporosis ? 

It is a rarefying osteitis, a form of osteomalacia peculiar 
i;o the young and adult horse. 

What are the causes ? 

They are obscure. A great many facts point toward a 
microbian origin, the pathogenic bacterium either acting as 



19-i PKINCIPLE.S OF VETERINARY SURGERY 

the irritant by directly invading the system, or a toxic agent 
enters some way or other. I have seen hundreds of cases in 
the South, but do not believe in a direct contagion. I think 
that accessory causes, by interfering with bone nutrition, j)re- 
dispose the creature to succumb to an invasion by a pathogenic 
germ, or some other toxic agent; as such accessory causes may 
be mentioned unwholesome stables, as are frequently met 
with in cities, faulty food, etc. While this disease has been 
frequently observed in the large cities, I have seen but three 
cases of osteoporosis in the past live years in Milwaukee, and 
two of these horses came to the city suffering with the dis- 
ease, while the third, a pony, was in town about one year 
before my attention was called to its "big head." 

Describe the symptoms of osteoporosis. 

Its beginning is often insidious. As a rule, the animal 
soon becomes fatigued, sweats easily and has a poor and 
irregular appetite. Or the animal is brought to you on 
account of a lameness. The vast majority of cases seen by 
me were either shoulder, hip or stifle lame. Other animals 
are stiff, experience difficulty in lowering the head, walk stiffly, 
stumble easily, the long bones of the extremities may enlarge. 
Synovial distention about the various joints is an early symp- 
tom. A close study of the bones of the face usually shows in 
the earlier stages of the disease a rounded state — that is, a 
bulging of the nasal and superior maxillary bones; and when 
one hand is rested upon the nose and the other hand against 
the chin, now making lateral motion with the lower jaw — 
that is, grating the teeth upon each other — a dull, muffled 
sound is produced. Fractures and distortions are common. 

How do you treat osteoporosis 9 

A change of climate gives the best result, even if it 



DISEASES OF ARTICULATIONS 195 

1)6 no more tliaii placing the animal into another barn; good 
food, lots of sunshine, no undue exposure or excess of work, 
bone dust and small doses of phosphorus are valuable 
adjuncts. 



DISEASES OF ARTICULATIONS. 

Arthritis. 

W hat is arthritis 9 

Inflammation of a joint. 
What structures of a joint may he affected in arthritis 9 

The most important one is the synovial membrane. This 
is a serous membrane encapsulating the joint and analogous 
to the peritoneum or pleura. When inflamed it is termed 
synovitis. But the inflammation of arthritis does not only 
confine itself to the synovial membrane, but may involve the 
bone, cartilage, ligaments and tissues about the joint. 

Depending on the cause of arthritis, luhat forms are recog- 
nized 9 
Traumatic, septic, infectious and aseptic arthritis. 

What other forms of arthritis occur 9 

Arthritis the direct result of an assault is termed primary. 
When the sequel of a contagious inflammation, it is known as 
secondary. It is termed hematogenous or metastatic *vhen 
the irritant is carried there by the blood, as in infectious dis- 
eases; viz. : contagious pleuropneumonia, septicemia, etc. 

Acccording to the course of the disease, luhat forms of arthritis- 
are established 9 
Acute and chronic arthritis. 



196 PRINCIPLES OF VETERINARY SURGERY 

What is polyarthritis ? 

That state wliere several joints are inflamed at the same 
time, as in rheumatism, pyemia, etc. 

What is monarthritis ? 

That state where only one joint is inflamed. 

What is specific arthritis ? 

An arthritis the result of a specific infectious disease, as 
glanders, tuberculosis, etc. 

What is periarthritis ? 

Inflammation of the tissues surrounding a joint. 
How do you classify arthritis from a clinical standpoint f 

Serous arthritis (arthritis serosa). 
What is serous arthritis 9 

Inflammation of a joint with a serous exudate into the 
joint cavity. 

W hat two main forms of serous arthritis are known ? 
Acute and chronic. 

What are the causes of serous arthritis ? 

Contusions and distortions, certain diseased states, as 
retention of the afterbirth, rheumatism. 

Describe acute serous arthritis ? 

Usually the result of a distortion or contusion of a joint 
leading to an aseptic inflammation, especially of the fetlock, 
hock and stifle ; followed by increased heat, decided pain 
and circumscribed fluctuation about the joint. 

In serous polyarthritis due to articular rheumatism there 
is in addition to the above symptoms also a decided elevatioa 
-of the temperature of the body. 



DISEASES OF ARTICULATIONS 197 

What becomes of the exudate poured into the joint cavity a» 
the result of a serous arthritis ? 

It is either absorbed, or, when remaining, chronic serous 
arthritis is the consequence. 

Describe chronic serous arthritis. 

It is either found in joints predisposed to it by heredity 
(the joint is of a sluggish disposition and limited assaults affect 
it readily), or the sequel of an acute serous arthritis. This condi- 
tion, also termed galls, is common in the hock, stifle and fetlock 
joints of colts. As a rule, this condition does not interfere 
with locomotion ; the symptoms of an acute serous arthritis 
are present minus painful states and increased heat about the 
affected joint. 

How do you treat acute serous arthritis 9 

Rest is essential. In the earlier stages cold applications, 
bandaging ; later, a warm moisture by Priessnitz fomenta- 
tions, iodine tincture or blisters are indicated. 

How do you treat chronic serous arthritis 9 

Most any treatment is unsatisfactory, as blisters and even 
the actual cautery usually give negative results. From time 
to time favorable reports reach us in regard to the treatment 
of these conditions by incision of the joint with subsequent 
antiseptic irrigations. Such treatment, while possible and of 
great value in man, and which, under favorable circumstances, 
may be used in the smaller animals — as the dog — nevertheless 
is, to say the least, a rather hazardous undertaking in the 
horse by reason of the possibility of a secondary infection,, 
which is practically an equivalent to a death verdict. 



198 PRINCIPLES OF VETERINARY SURGERY 

Purulent Arthritis (Arthritis Purulenta). 

Hoiu is purulent arthritis produced ? 

Pus producing bacteria may reach the joint via the blood 
current, as in pyemic polyarthritis of calves and colts, or a 
purulent inflammation of the soft tissues surrounding a joint 
may extend into the joint by contiguity, or, as is more com- 
monly the case, pus producing bacteria are carried into the 
joint through a wound perforating the joint. 

Describe purulent arthritis. 

There is high fever and great constitutional disturbance. 
Pain and heat and a diffused swelling about the joint are 
marked. In those cases where a penetrating wound was the 
cause of it, a purulent synovial discharge (opaque, straw color) 
is seen. Periarticular abscesses may be observed in any case 
of this sort. 

Is purulent arthritis a serious condition 9 

Decidedly. In the horse these cases are soon complicated 
with septicemia or septicopyemia, rapidly causing death, 
especially when the larger joints, such as the stifle or hock, 
are infected. 

In case recovery should set in, ivhat cha^iges take place in a 
joint previously affected with purulent arthritis 9 

Anchylosis of the joint will be the result. 
How do you treat purulent arthritis ? 

For economic reasons, at least in the larger animals, as 
the horse, no treatment is attempted. The indications are to 
puncture the joint, asepticize it, and keep it so by continuous 
irrigation. In the dog, resection of the joint or amputation 
can be practiced. 



DISEASES OF ARTICULATIONS 199' 

Deforming: Arthritis (Arthritis Deformans). 

What is arthritis deformans f 

It is a chrouic aseptic arthritis cliaracterized by a perma- 
nent and material change of the shape and structure of a 
joint. 

What are its causes 9 

Usually a traumatism, as contusions or distortions. Her- 
edity — that is, a predisposition to it — plays an important role; 
chronic articular rjieumatism. 

Describe the changes talcing place in arthritis deformans. 

The disease usually starts in the articular cartilage. The 
cartilage cells proliferate, thus robbing the cartilage of its 
firmness. At the point where the articular surfaces come in 
contact — that is, rub each other — the cartilage is ground down 
more and more until eventually the epiphyses of the bones 
touch each other, the balance of the hyaline cartilage — that 
is, that portion not in actual contact with each other, but 
more or less free at the margin — also proliferates, forming 
excrescences. That portion of the periosteum covered by the 
synovial membrane where the latter is fixed to the margin of 
the joint also undergoes inflammatory changes by contiguity, 
as the result of which subsynovial exostoses are formed, read- 
ily seen or felt, and according to their location variously 
termed spavins or ringbones. The synovial membrane may 
in time become thickened as the result of the inflammatory 
process, this being especially the case at those points where it 
is fixed to the articular margins. Inflammatory changes, 
such as thickening of the connective tissue ligaments about 
the joint, as well as an ossifying periostitis, may become a 
natural consequence of the inflammatory process originally 



200 PRINCIPLES OP VETERINARY SURGERY 

started in the hyaline cartilage of the articular cartilage^ 
gradually extending to these structures. 

What are the terminations of arthritis deformans 9 

The pathological changes just described either advance to 
such an extent that the joint becomes useless or a more favor- 
able termination sets in by synosteosis. 

How does arthritis deformans terminate favorably by synoste- 
osis 9 
To begin with, this only occurs in joints with limited 
motion, as in the tarsus and carpus. The favorable termina- 
tion lies in the fact that the articular surfaces, bared of their 
hyaline cartilage by the diseased process, become fused — that 
is, anchylosed. In such joints as the hip or stifle the free 
motion prohibits anchylosis ; such animals therefore remain- 
ing cripples. 

What articulations are mainly exposed to arthritis defor- 
mans ? 
In the horse, the hock joint, where the exostosis is known, 
as spavin ; the carpus, the stifle joint, the hip, the latter espe- 
cially in the dog, cattle and more rarely in the horse. 

Is the spavin aliuays the residt of a true arthritis chronica- 
deformans ? 
To be the result of a true chronic deforming arthritis, the 
pathological lesion must start in the articular cartilage of a 
joint. No doubt some spavins take their origin from this 
point. The classical histological studies by Gotti at the 
same time show that in many spavins the primary pathologi- 
cal lesions originate in the osseous tissue, and as the result of 
this primary osteitis a secondary chronic deforming arthritis 
sets in. This happens as follows : At first there is an osteitis. 



DISEASES OP ARTICULATIONS 201 

of the cuneiform medium and magnum and metatarsus ; this 
osteitis by contiguity involves the articular cartilage in the 
inflammatory process, and a chondritis — that is, inflamma- 
tion of the cartilage — with subsequent proliferation of the 
cartilage cells, softening, etc., results, which now leads to a 
chronic deforming arthritis. Another way is this : There is at 
first an osteitis of the cuneiform medium and magnum, the 
overlying periosteum inflames and ossifying periostitis with 
its product, an exostosis — that is, the visible spavin with 
anchylosis of the articular surfaces — follows. The correctness 
of Gotti's claims have stood the tests of repeated investigations, 
also aided by the fact that in many spavins both the articular 
cartilage and periosteum are normal. The above applies 
equally well to ringbones. In periarticular ringbones no 
arthritis at all is present, but we have to do with an ossifying 
periostitis, the latter taking its origin at the point of insertion 
of the phalangeal ligaments. 

How do you treat arthritis deformans ? 

By rest, blisters and the actual cautery. 

Of less importance from a surgical standpoint are the fol- 
lowing forms of arthritis : 

Describe fibrinous arthritis {arthritis fibrinosa). 

The serous exudate in this form of arthritis contains an 
excess of fibrin, as a result of which a slight crepitation can 
be obtained by palpation. Anchylosis of the articular surfaces. 
is a frequent sequel. 

Describe panneous arthritis (arthritis pannosa). 

A chronic arthritis met with in chronic articular rheuma« 
tism and old galls, the articular cartilage being covered with 
vascular granulations which in time bring about fibrous adhe- 
sions, or, in other words, a fibrous anchylosis. 



202 PRINCIPLES OP VETERINARY SURGERY 

Describe dry chronic arthritis (arthritis chronica sicca). 

Quite frequently seen in horses and dogs. It is charac- 
terized by a fibrillary degeneration of the intercellular sub- 
stance of the cartilage, followed by proliferation of the carti- 
lage cells, which, breaking down, its surface exhibits an 
eroded, worm-eaten appearance. As the result of the pressure 
and rubbing motion by the epiphyseal ends of the bones, the 
cartilage becomes thinner and thinner until eventually the 
bone, deprived of its articular hyaline cartilage, is exposed. 
This form of arthritis is observed in the articular cartilage 
of joints of animals kept for a long time in the stable on 
account of serious lameness. It is seen in the beginning of 
arthritis deformans, etc. 

Describe fungous arthritis. 

It is of little practical moment in animals. In birds, 
where it is more frequently met with, it attacks the joints of 
foot and wing ; in swine, the hock and knee ; in cattle, knee, 
stifle and hip joints. It consists of an inflammation of the 
synovial membrane with fungous -like deposits upon it, as 
well as necrosis and rarefaction of the bones and cartilage. 

W hat is articular rheumatism ? 

A serous polyarthritis due to a general infection. 
W hat joints are usually affected ? 

The stifle, hock and carpus. 

What complication is dangerous and common to it ? 
Endocarditis. 

Is it a chronic or acute disease ? 

While setting in acutely, its course is a chronic one. 



DISEASES OF ARTICULATIONS 203 

Describe the changes in the joints. 

As a rule, a number of articulations are attacked at the 
same time (polyarthritis). At first there is a serous synovitis 
leading in some cases by its chronicity to an arthritis 
deformans. In the acute cases the synovial membrane is red- 
dish and swollen. The articular cartilage is also reddish, 
"becomes later yellowish and has a velvety appearance. The 
epiphyseal ends of the bones appear reddened and even hem- 
orrhagic, the marrow showing a similar state. The tissues 
surrounding the joint are hyperemic and cedematous. In 
advanced stages the synovial membrane is very much thick- 
ened, the cavity of the joint may show the changes of a pan- 
neous arthritis, the articular cartilage undergoes fatty degen- 
eration and ulceration. A true arthritis deformans is occa- 
sionally observed. Of other symptoms, those of endocarditis, 
pleurisy and peritonitis complicate the case. 

TF hat animals are most subject to articular rheumatism 9 
Especially cattle ; more rarely horses, dogs, swine. 

Sow do you treat articular rheumatism 9 

Main reliance is placed upon large doses of sodium 
salicylate. 

What is 'pyemic and septic arthritis of the young ? 

A purulent polyarthritis of metastatic origin, the result 
of an infection of the umbilical wound of the newly born. 

Outline the diseased process . 

Infection of the navel leads to the formation of a purulent 
thrombus in the bloodvessels of that region ; in other words, 
there is a purulent thrombophlebitis and thromboarthritis. 
Little bits of this purulent thrombus break off (embolus) 
"which, carried away by the circulation, produce a general 



204: PRINCIPLES OP VETERINARY SURGERY 

systemic infection wliicli may be a pyemia or septicemia^ 
Soon after, a febrile reaction is shown by the animal, tbe^ 
joints, especially the bock, stifle, bip, knee, elbow, sboulder- 
joints swell, terminating by abscess formation in tbem. Such, 
animals live from two to three weeks, when they die with., 
symptoms of either pyemia or septicemia. 

Describe the most important changes in septic or pyemic- 
arthritis. 
The synovial membrane is red and swollen. The synovia, 
is increased in quantity and turbid or even replaced by pus. 
The articular cartilage and even at times the bones ar& 
necrotic. The tissues surrounding the j oints exhibit abscesses. 
The other post mortem changes are those peculiar to pyemia, 
or septicemia. 

Uoiu do you treat septic arthritis ? 

The treatment of the affected animal is practically hope- 
less ; the main feature is prophylaxis, as disinfection of tha- 
umbilicus and stable. 

Describe gouty arthritis {arthritis urica). 

Peculiar to birds, occasionally seen in the dog ; supposed 
to be the result of an excess of uric acid in the blood and tis- 
sues, impaired metabolism, etc. It is characterized by 
deposits of sodium biurate in and around joints. 

What is periarthritis ? 

It is an inflammation of the soft tissues surrounding a. 
joint. 

Name the soft tissues involved in the inflammatory process. 

The peritoneum, synovial sheath of tendons and synovial 
"bursse. 



DISEASES OF ARTICULATIONS 205 

'Give a common example of periarthritis. 

Periarticular ringbone, taking its origin from the point 
of insertion of the lateral ligaments of the first interphalan- 
,geal articulation. 

JExplain the nature of a periarticular ringbone. 

This form of ringbone is the result of a primary chronic 
ossifying periostitis produced by a tugging upon the lateral 
ligaments of the joint, such as follows faulty positions of the 
limb, for instance, in contrast to true articular ringbone, 
which starts either as a primary osteitis or occasionally as an 
•arthritis deformans, showing that there is a marked difference 
laetween articular and periarticular ringbone. 

Luxation of a Joint. 

^fVhat is luxation 9 

A permanent separation of two articular surfaces from 
each other with partial or complete laceration of its liga- 
ments. 
What is a subluxation ? 

A partial or incomplete dislocation ; that is, the articular 
■ends are more or less in contact with each other, the liga- 
ments being rarely torn. 
What is a simple, what a complicated luxation ? 

In the former there is no serious damage done to the sur- 
Tounding soft parts or the bones, the articular ends are not 
■exposed to the air ; while in the latter there is serious injury 
of soft parts or bones, as, for instance, a fracture, the articu- 
lar ends being in contact with the external air. 
What is a recent, what an old luxation ? 

The terms recent and old in this instance are not sug- 
gestive of the time passed since the accident, but indicate the 



206 PEINCIPLES OF VETERINARY SURGERY 

changes in tlie parts involved. Therefore, in the former the 
displaced bone is not yet fastened by tissue changes in the 
place into which it was forced, while in an old dislocation the 
displaced bone is held firmly in its new location by tissue 
changes. 

What is relapsing or habitual luxation ? 

It is a dislocation recurring frequently and from slight 
cause. 

Depending on the cause, tvhat forms of dislocations are recog^ 
nized f 

1. Traumatic dislocations : Due to sudden force. 

2. Pathological or spontaneous luxations : Due to inflam- 
matory and other pathological processes. 

3. Congenital dislocations : Due to a congenital malfor- 
mation of the joint. 

Hoiu does sudden force produce traumatic luxations ? 

The joint is either dislocated directly by a blow of some 
sort, the latter driving the articular ends apart, or external 
violence may act indirectly in this way : A bone struck at a» 
distant part transmits the force of this blow to its end, which 
drives it (the bone) out of the joint. Finally, sudden and 
severe muscular contraction may be an active cause of luxa- 
tion by pushing the head of the bone powerfully against the 
weakest part of the ligaments retaining the articular ends. 

Give some examples of traumatic dislocations. 

In the horse, the more common ones, although not as 
frequent as fractures, are upward dislocation of the patella 
by sudden powerful contraction of the triceps f emoris, as seen 
in kickers ; luxation of the cervical vertebrae (not a rare sight 
when a lot of bronchos undergo training) ; dislocation of the 



DISEASES OF ARTICULATIONS 207 

metacarpo-plialangeal articulation, occasionally seen in run- 
ners. 

In the ox ; sacro-iliac articulation in cows dislocated dur- 
ing severe labor or by empiric assistance, and liip joint. 

In the dog, bip, elbow, cervical vertebrae, inferior maxilla. 

Name some 'pathological processes which produce spontaneous 
luxation ? 

In these dislocations one deals with a joint relaxed by 
previous disease and thus predisposed to luxations. Such 
may be a deforming arthritis or a chronic serous arthritis and 
edema of the retaining ligaments, as a result of which they 
easily yield to pressure, thus favoring dislocations. 

Describe congenital dislocations. 

In these cases the animal is born with a malformation of 
a joint, as a result of which the bone cannot retain its normal 
position. Those dislocations met with in the newly born and 
occurring during delivery as the result of rough handling do 
not belong here, but must be classified among traumatic dis- 
locations. The elbow joint of the dog is subject to congenital 
luxation. 

What are the symptoms offered by a dislocation ? 

Generally speaking, they are : Simple dislocation, abnor- 
mal rigidity in one direction and excessive mobility in another 
direction. In joints not covered with a heavy layer of muscles 
there is a visible change in the shape of the articulation. In 
case the luxation affects an articulation of \h.Q leg, the normal 
position of the bony columns is disturbed, the part may be 
abnormally extended or flexed, abducted or adducted. The 
leg appears longer in incomplete luxations, while it appears 
shorter than normal in complete luxations. In luxations of 
joints of the leg there is severe lameness and pain. 



208 PEINCIPLES OF VETERINARY SURGERY 

In complicated luxations the symptoms peculiar to severe 
injury of the surrounding soft parts, as well as fracture of 
the dislocated bone, will be observed, such as external 
wounds, rupture of tendons, laceration of bloodvessels large 
and small, injury to more or less important nerves, open 
joint, etc. 
Describe the articular changes following a luxation. 

There is invariably a rupture of the capsular ligament ; 
the surrounding tissues — that is, the ligaments, nerves, blood- 
vessels, tendons and muscles — are either stretched or torn. An 
exception to this rule forms the dislocation of the patella, 
sacro iliac articulation and the symphysis pnbis. In the 
so-called spontaneous or pathological dislocations, as seen in. 
dislocation of the patella, chronic arthritic changes are fre- 
quently observed. As soon as luxation of a joint occurs and 
the capsular ligament is torn a hemorrhage into and surround- 
ing the joint, possibly including the adjacent connective tissue, 
muscles, etc., takes place. The old socket is filled with blood 
and the dislocated bone is imbedded in a bloody area. If an 
uncomplicated dislocation is reduced early, an almost normal 
condition is obtained in due time, unless some of the lesions 
undergo a faulty repair leading to subperiosteal formation of 
bone or periarticular thickening. In old luxations the pro- 
cess of repair is quite different. Let us suppose that the head 
of the femur has left the cotyloid cavity. I have seen and 
described in the current literature two such cases in mules 
observed in South Carolina. In horses it is very rare, but 
more common in dogs. The head of the femur in its new 
position is in contact with a bony surface, against which it 
presses. As a result of this pressure an osteitis and periostitis 
results which in turn leads to formation of bone around 
the head of the femur, and anew bony socket, even lined with 



DISEASES OF ARTICULATIONS 209 

cartilage and endowed with a capsular ligament, may be 
formed. The lacerated and displaced connective tissue around 
the head of the femur, as well as the injured muscles, form 
adhesions holding the dislocated bone firmly in place. 

Outline the treatment of dislocations. 

Provided such is possible, reduction and retention of the 
•dislocated parts are primary essentials. In luxation not 
accompanied with serious lesions of the constituents of the 
joint or surrounding tissues, the rent in the capsular ligament 
soon heals, while the hemorrhage into the joint and surround- 
ing tissues is absorbed. In the larger animals, such as the 
iorse or cow, reduction is very difficult and retention often 
impossible ; in the smaller animals — as the dog, for instance — 
the dislocation can be reduced more readily, but the restless- 
ness of the patient renders retention of the reduced articular 
ends very difficult or impossible. In old luxations of the hip 
of the dog no attempts at reduction are made ; it is best to 
await the formation of a new socket by nature's efforts at 
repair. Dislocation of the inferior maxilla of the dog and 
luxation of the patella of the horse are easily reduced. For a 
«ure of habitual luxation of the patella, section of the internal 
patellar ligament has been advocated more recently. I have 
operated on three horses, but the time which has elapsed since 
the operation is too limited to permit of conscientious criti- 
cism. 

Distortion (Sprain). 

What is a distortion f 

A temporary displacement of two articular surfaces from 
each other, followed by an immediate return to place and by 
a partial or complete laceration of the retaining ligaments. 



210 PRINCIPLES OF VETERINARY SURGERY 

Where does the main point of difference lie in a dislocation 
and distortion ? 

In the dislocation the separation of the articular ends is 
permanent and requires artificial aid for its reduction ; in dis- 
tortion the separation is momentary and the displaced articu- 
lar ends snap back into place by their own account. 

Depending on the severity of the sprain, ivhat two forms are 
recognized ? 

1. Simple : No serious damage to the joint or adjacent 
tissues. 

2. Complicated : More or less serious injury to the liga- 
ments, synovial membrane, bone, cartilage and soft tissues 
surrounding the injured articulation. 

W hat are the causes of distortions ? 

Anything causing a sudden wrench or twist of a joint, as 
slipping, getting caught in street rails, stumbling, faulty 
positions of limbs, faulty shoeing. 

How do faulty positions of J imhs produce distortions ? 

It is a well-known clinical fact that horses which toe out 
or toe in often furnish clinical material for'these cases. These 
animals have often an awkward gait — that is, they stumble 
quite readily — as a result of which sprains follow ; further- 
more, the retaining ligaments of their phalangeal articula- 
tions especially are in a somewhat relaxed state, the articular 
surface of their joints, by reason of the peculiar position 
which the bony column exhibits, is irregularly weighted ; that 
is, one side of the joint bears more of the body weight than 
•its partner, leading to a straining of the ligaments of the 
other side of such a joint. 



DISEASES OF ARTICULATIONS 211 

How does improper paring of the lioof or shoeing produce 
distortion ? 
In a way similar to tlie one just explained. A hoof, one- 
quarter of which is left higher than its mate, will, at the 
moment it is placed upon the ground to receive the weight of 
the body, wabble more or less; in other words, the phalangeal 
articulations are at that moment twisted, which, as easily 
seen, leads to distortions. 

W hat articular changes take place in simple and complicated 
distortions f 

In simple sprains the capsular ligament is usually crushed, 
but may be torn ; the ligaments, not being elastic, cannot 
stretch, but elongate a little; as soon as their limit is reached 
a few of the fibres rupture or the whole ligament tears. 

In simple dislocation there is bleeding within and without 
of the articulation. In complicated distortions, the capsular 
membrane is likely to be torn, the ligaments lacerated more 
or less, the entire ligament may be detached from the bone, 
there may be a fracture or dislocation, extensive hemorrhage 
into the joint cavity and surrounding tissues. 

What symptoms does a distortion produce ? 

Sudden lameness ; quite often after a few steps this first 
or primary pain disappears, to reach a high degree as soon as 
the animal obtains some rest and is then started. This so- 
called secondary pain is the result of the setting in of an 
inflammatory reparative process. Now heat, swelling, at first 
doughy, later firm, pain on palpation, especially on rotation 
of the joint, are evident. 

How do distortions termiiiaie 9 

In those cases where the capsular ligament and the other 
retaining ligaments are not torn, recovery takes place in a few 



:212 PKINCIPLES OF VETERINARY SURGERY 

days, but when tlie retaining ligamentous apparatus is lacer- 
ated a periarthritis develops in a few hours. These cases 
require four to six weeks for recovery. Whenever the liga- 
ment is actually torn the synovial membrane is seriously 
injured and possibly the bone, when there is a considerable 
hemorrhage into the joint cavity, the chances for a complete 
recovery are very slim, as a marked joeriarthritis may lead to 
the formation of a periarticular ringbone, or the seriously 
injured synovial membrane and joint become chronically dis- 
eased, exhibiting a chronic serous arthritis ; even an arthritis 
deformans may be the result. Septic complications are not 
•excluded, as the skin may have been injured at the time the 
animal fell or stumbled. The above shows that in all distor- 
tions accompanied with severe and persistent lameness the 
prognosis must be a guarded one. 

Outline the treatment of distortions. 

The first point is rest. When the season and conditions 
of the barn permit it, cold water applications with firm band- 
aging of the sprained joint is indicated the first day. From 
the second day on, moist heat and compression of the joint 
follow. Where this line of treatment is impossible, a blister 
Is applied or combined with the actual cautery. In some 
instances, where all these means fail, neurectomy may be 
practiced. 

Contusion of a Joint. 

What do you understand by a contusion of a joint ? 

It is a bruising, a subcutaneous injury of the tissues sur- 
Tounding and composing a joint. 

TV hat are the causes of such contusions ? 

Blows, pressure, etc., either act directly upon a joint or a 



DISEASES OF ARTICULATIONS 213" 

distant part is struck and the force of the blow transmitted to 
the epiphyseal ends of the bones. The latter represents an in- 
direct contusion. 

What articular changes take place in contusions of joints f 

In direct contusion the capsular ligament and periarticu- 
lar tissues are mainly injured, while in the indirect contusion 
the articulating bony ends, by striking against each other, 
compress and injure their hyaline cartilage, and even the 
bones themselves may fracture as the result of the blow. 

What are the symptoms of articular contusion ? 

As a rule, the hemorrhage into the joint cavity in contu- 
sion is considerable; as a result of which a fluctuating swelling 
about the joint appears; otherwise the symptoms are those of 
a distortion only ; the phenomena are all of a milder type. 

Hoiu do articular contusions terminate ? 

As a rule, favorably. Occasionally a chronic serous 
arthritis — that is, a gall — remains behind. Of course contu- 
sions complicated with fractures demand an unfavorable 
prognosis, at least in the larger animals. 

Outline the treatment of contused articulations. 

In the earliest stages cold and pressure to prevent further 
hemorrhage into the joint and surrounding tissues ; later,, 
moist heat and compression ; generally speaking, a blister is 
the most reliable and least troublesome treatment, y 

Anchylosis. 

What is articular anchylosis ? 
Destroyed joint mobility. 



214 PRINCIPLES OF VETERINARY SURGERY 

What kind of tissues are found to he the cause of anchylosis 
of joints f 
Joints are rendered immovable by fibrous, cartilaginous 
and bony adhesions. 

What is an intracapsular, luhat an extracapsular anchylosis? 

In the former, also known as intra-articular anchylosis, 
the consolidating mass lies within the joint cavity, while in 
the latter it lies external to the capsular membrane. 

Give the etiology of articular anchylosis. 

In navicular hoof disease, in spavin and articular ring- 
bone, it is the result of a deforming arthritis. Anchylosis of 
the vertebral column, as in old horses, is due to ossification of 
the intervertebral fibrocartilages. It may be due to an ossify- 
ing periostitis such as arises in the course of a periarthritis. 
Generally speaking, it is the result of a chronic arthritis. 

W hen does the surgeon encourage the formation of an anchy- 
losis 9 
As soon as a joint is anchylosed it becomes stiff, and not 
being able to move any more, it also becomes painless. This 
painless state is what the surgeon desires to obtain, as the 
absence of pain means equally well — in a great many cases at 
least — an absence of lameness. For this reason, for instance, 
a horse spavin-lame is fired and blistered with the hope to 
anchylose the parts and thus remove pain and lameness. 

How do you treat anchylosis ? 

In animals, at least, it is incurable. Such operations as 
osteotomy, resection of joints and arthrotomy, while invalu- 
able to man, are of little practical interest to the veterinary 
surgeon. 



DISEASES OF ARTICULATIONS 215 

Articular Contracture. 

W hat do you understand by articular contracture 9 

An incomplete anchylosis — that is, a permanent impair- 
ment of joint mobility — accompanied by fixation of the joint 
at an abnormal angle. 

What are the causes of articular contractures 9 

They may be acquired and the result of diseases of ten- 
dons, muscles, nerves, skin or joints, or they are congenital, in 
•which case the creature is either born with them or predis- 
posed to them. 

Name the various forms of joint contractures. 

(1) Arthrogenous contractures, (2) tendogenous, (3) myo- 
genous, (4) neurogenous, (5) cicatricial, (6) congenital. 

What are arthrogenous contractures ? 

In these, pathologic lesions in or close to the joint hinder 
free mobility. 

Give examples of arthrogenous contracture. 

In the earlier stages of arthritis deformans, as in articular 
ringbone, exostoses about the joint, loose bodies in the joint. 

Which is the most common example of arthrogenous contrac- 
ture in the horse ? 
That due to articular arthritis. 
What is a tendogenous contracture ? 

In this form the mobility of a joint is limited by adhe- 
sions and shortening of flexor tendons. 

Give an example of tendogenous contracture. 

The one most commonly seen is met with in the foreleg of 
the horse, where the mobility of the phalangeal articulations 



216 PRINCIPLES OF VETERINARY SURGERY 

"becomes limited as the result of chronic inflammation of the 
flexor pedis perforans and perforatus, the latter being fol- 
lowed by adhesions and shortening of these tendons. 

W hat is a myogenous contracture ? 

In these, free mobility of the joint is interfered with by a 
shortening of muscles. 

Give an example of myogenous contracture. 

In the crooked tail as the result of contracture of the lat- 
eral coccygeal muscles, in the so-called wry neck {caput 
ohstipum), there exists a contracture of the mastoido humer- 
alls. In the so-called sprung knee, where a contracture of the 
external and oblique flexor of the metacarpus is found. 

What are neurogenous contractures ? 

In these the free mobility of the joint is limited, as th& 
result of faulty enervation of certain muscles. 

Give an example of neurogenous contracture. 

This condition is quite often seen in the newly born ani- 
mal, especially colts, most likely due to a paralytic state of 
the extensor muscles of the legs, as the result of which the 
animal knuckles over. 

What is a cicatricial contracture ? 

In this form the mobility of the joint is handicapped by 
the formation of a large amount of scar tissue in close prox- 
imity to a joint, especially when involving the flexor surface 
of a joint ; such cicatrices may be due to burns, wounds, and 
are quite common in our country, especially where barbed 
wire fences are used, the flexor surface of the hock and 
fetlock being common sites of such cicatrical contractures. 



DISEASES OF ARTICULATIONS 217 

What is congenital contracture f 

The only one of practical interest is the neurogenons con- 
tracture seen in the newly born colt, where, as the result of 
a jjaralytic state of the extensor muscles of the legs, the young 
creature knuckles over in the fetlock more or less. 

Outline the treatment of contractures. 

In arthrogenous and cicatrical contractures, at least 
always in the former, the case is hopeless. In tendogenous 
contracture tenotomy is to be tried and is sometimes success- 
ful. In myogenous contractures myotomy is indicated, giv- 
ing in the sprung knee fair results, and usually good, while not 
permanent, results in crooked tails; the congenital neuroge- 
nous contractures are treated by mechanical appliances, such 
as splints, bandages, etc. 

What is the difference between a contracture and a contrac- 
tion ? 
From a medical point of view the former represents a 
permanent rigidity of a part, while the latter represents a 
temporary rigidity. For instance, in lacerations of the exter- 
nal and oblique flexors of the metacarpus, scar tissue forms,, 
leading to a shortening (more or less), and therefore perma- 
nent rigidity of these muscles in this instance is a contracture^ 
while a temporary contraction of these or other muscles, for 
that matter, as the result of a clonic spasm, would lead to a. 
temporary rigidity of the muscle ; in other words, to a con- 
traction. 

Lioose Bodies in the Joint (Corpora Libra). 

What are corpora libra 9 

These are smooth, white bodies of variable size, appearing 
single or multiple, in a joint cavity or synovial tendon sheath. 



218 PRINCIPLE? or VETERINAEY SURGERY 

either floating free or attaclied by a pedicle to the synovial 
mem.'brane. 

What are the corpora libra composed of 9 

Fibrous tissue, bony or cartilaginous, or a mixture of 
these. 

How large are they ? 

They vary in size from millet seed to pigeon Qgg size. 

How are copora libra developed ? 

1. Usually due to a traumatism, as a piece of cartilage of 
bone may have been loosened by a complicated distortion, 
contusion of a joint, etc. 

2. • From villous outgrowths of the synovial membrane. 

3. From blood clots and fibrin poured out during an 
acute inflammation. 

4. From detached pieces of cartilage, as in arthritis 
deformans. 

5. From extra capsular neof ormations which have invaded 
the joint cavity. 

Are corpora libra often seen in animals ? 

They are rare, and only occasionally seen in the knee, 
hock and stifle joints. 

W hat symptoms do they give rise to ? 

By wedging the joint a sudden lameness of intermittent 
character which cannot be accounted for suggests loose bodies 
in the joint. Careful palpation may or may not detect them. 

How do you treat loose bodies in the joint ? 

The difficulties connected with executing an aseptic 
operation in the horse and applying the proper dressing to 



DISEASES OF TENDONS 219 

teep the wound aseptic (a vital factor in a joint) would sug- 
gest tlie desirability not to operate the horse, while the dog 
offers better chances for a successful arthrotomy. 



DISEASES OF TENDONS. 

Inflamraation of Tendons (Tendinitis). 

What is tendinitis 9 

An inflammation of a tendon. 

Name the causes of tendinitis. 

Predisposed to this trouble are animals with a sloping- 
fetlock, those with poorly developed — that is, weak — tendons, 
animals with low heels or long toes, the latter frequently seen. 
in our trotting horses, where the toes are allowed to remain 
excessively long by some trainers; nutritive disturbances, 
such as follow prolonged idleness in the stable; infectious dis- 
eases. Direct causes, usually of a traumatic nature, of pri- 
mary tendinitis are prolonged hard work, jumping, gallop- 
ing, hard pulling, as in runners, trotters and draught horses ; 
contusions, the result of kicks, etc., are occasionally the cause. 

Secondary tendinitis — that is, a tendinitis the result of an 
extension of an inflammatory process to the tendon from 
neighboring parts — are seen in cellulitis of the synovial sheath 
in consequence of aseptic cellulitis of the plantar cushion and 
in those inflammations of tendon sheaths, sequels to conta- 
gious pleuro-pneumonia, etc. 

In Italian and Russian horses, the presence of the filaria 
cincinnata and spiroptera reticulata is given as a cause of 
tendinitis. 



220 PEINCIPLES OF VETERINARY SURGERY 

What anatomical lesions are found in tendinitis ? 

More or less laceration of tendon fibres, accompanied by a, 
sero-hemorrliagic exudate infiltrating the interfasicular con- 
nective tissue, is the first step. ISTow the inflammation extends 
to the peritendineum and paratendineum, causing a swelling- 
of tendon as the exudate pushes apart the bundles of tendoiL 
fibres. The sero-hemorrhagic exudate first alluded to is. 
replaced by an invasion of the parts by leucocytes; new blood- 
vessels and connective tissue are formed. The granulation 
tissue which is formed springs mainly from the paratendi- 
neum, the tendon sheath and a limited amount of it comes 
from the tendon cells of the ruptured tendon fibres. This 
soft granulation tissue gradually undergoes changes until 
eventually it becomes hard cicatrical tissue, which may not. 
only be simply connective tissue, but in its transformation, 
becomes cartilaginous or even bony. 

Three years ago, while studying double tibio peroneal 
neurectomy, I bought two horses with spavins. These ani- 
mals also suffered with chronic tendinitis. Microscopical 
examinations made of the diseased tendons showed patches of 
osseous tissue in the cheek ligament of the perforans, espe- 
cially abundant where the ligament blends with the flexor 
pedis perforans. 

What danger is connected -with the formation of scar tissue in, 
tendinitis ? 

It may lead to a tendogenous contracture and render tho^ 
animal a cripple. 

Hoiv is this brought about f 

All scar tissue has a tendency to retract. Consequently 
the scar tissue the result of a tendinitis shortens the tendon, 
thus altering materially the angularity of the various joints 



DISEASES OF TENDONS 221 

"Controlled by that tendon. In serious inflammations, not only 
scar tissue forms between the ruptured fibres of the tendon, 
but adhesions with neighboring parts, as other tendons and 
tendon sheaths, occur. 

How do you explain the fad that in some cases of tendinitis 
the tendon does 7iot shorten, while it does in others 9 
Retraction of the scar tissue can only take place when one 
end of the tendon is relaxed, so the scar tissue may take up 
the slack, so to speak. 

<r^'ye an example to this effect. 

Suppose that some part of theperforans tendon is affected 
:and scar tissue forming. As a result of this, the animal has 
pain and does not care to support much weight upon the lame 
leg, as by doing so the tendon is rendered tense, which in 
turn causes pain. To avoid pain the animal eases the ten- 
sion upon the perforans by more or less volar flexion of the 
palangeal articulations — that is, knuckles over — resting the 
hoof upon the toe. At this moment the perforans tendon is 
slack and the retracting scar tissue can therefore shorten the 
tendon, which is impossible when full weight is borne by the 
hoof, as under those circumstances there is no give to the ten- 
don and consequently the scar tissue cannot retract. 

What practical deduction can he made from this ? 

Get your patient to support weight as soon as possible 
"with the affected foot, to counteract the action of forming 
scar tissue. 

What are the terminations of tendinitis ? 

1. Complete recovery, only possible in very slight cases. 

2. Partial recovery; in these instances the tendon remains 
permanently thick; depending on the severity of the lesion. 



222 PRINCIPLES OF VETERINARY SURGERY 

the animal either works pretty well, or there is chronic lame- 
ness, with, in the worst type, tendinous contracture. 

What does the prognosis of these cases depend on 9 

In running horses, unless they can be kept from hard and 
prolonged work, the prognosis is unfavorable, but they usu- 
ally do well as drivers and saddle horses. In carriage horses 
and heavy draughts, the prognosis is more favorable. The 
facts to be considered are : how important a tendon is 
involved; how serious are the lesions; what amount of swell- 
ing is present; does the animal support weight; is more than 
one leg involved. The latter point is very important, as in 
these cases the creature is obliged to support weight with the 
diseased structures, and under such circumstances the healthy 
tendon fibres may give way and the animal becomes what is 
vulgarly termed "broken down," followed by changes in the 
angularity of the articulations, the limiting apparatus of 
which the diseased tendon was. 

What are the symptoms of tendinitis f 

Pain and swelling of the tendon are the most important 
ones. In the earlier stages there is also increased heat of the 
parts, finally a change in the angularity of the phalangeal 
articulations. This is seen in the earliest stages by changing- 
the position of the ^ormal angle of the joint ; the animal 
transfers the weight of the body to the bony column, thereby 
relieving the tendon. In old cases the change in the position 
of the articular angle is due to the retraction by the scar 
tissue. 

What kind of swelling is seen in the various stages of tendin- 
itis ? 
Palpation reveals a diffuse, almost soft, swelling in the 
"beginning, due to the fact that the bundles of tendon fibres 



DISEASES OF TENDONS 223 

are separated by a liquid exudate; later, as granulation tissue 
develops, the swelling becomes firm, until finally it is hard. 

How do you palpate a tendon ? 

Always examine a tendon for thickening and for painful 
states by raising that part of the leg off the ground, as it is 
impossible to make a thorough examination — or one beyond 
criticism — by allowing the animal to stand upon the affected 
leg (see my work on " Clinical Diagnosis of Lameness in the 
Horse," page 19). 

What tendons are usualhj affected hy tendinitis 9 

The flexor tendons of the foreleg, more rarely those of 
the hindleg, as the flexor pedis perforans or more commonly 
its strong stay coming from the great posterior ligament of 
the carpus ; the suspensory ligament (superior sesamoidal 
ligament) and the flexor pedis perforatus. 

OuUine the treatment of tendinitis. 

Rest is essential, with a run to grass if possible after the 
lameness has disappeared. Shorten long toes, raise low heels 
and remove toe calk. The first two days, continuous cold; 
later, moist warm applications, with a pressure bandage (take 
two rolls of oakum, place them upon either side of the tendon 
and apply the bandage). Change the dressing every four 
hours ; by doing so a change of temperature takes place in 
the affected parts, beneficially jnfluencing the process of 
absorption. Unless the case is clearly making a recovery 
under this treatment, apply a blister, which, together with the 
line firing, is at once applied to all chronic cases. In chronic 
tendinitis with tendinous contracture, where the animal 
knuckles over so completely in the fetlock that the flexor 
tendons are no longer rendered tense, tenotomy may give 
relief. Purulent states are treated by incision to give drain- 



224: PRINCIPLES OP VETERINARY SURGERY 

age, with, irrigations of antiseptic solutions. Under certain 
conditions, resection of the tendon, as in nail pricks, with, 
subsequent necrosis of the perforans tendon, is indicated, sav- 
ing many a horse from certain death, provided it is executed 
sufficiently early. 

Which is the most satisfactory method to blister a horse'' s ten- 
dons for chronic tendinitis ? 
Clip the hair along the tendon, rub in thoroughly with, 
good pressure for at least five minutes a red iodide of mercury 
blister in the proportion of 1 : 5, apply over this a layer of 
absorbent cotton and over this rather loosely a derby bandage. 
Tie up the horse for 48 hours and leave the cotton dressing 
undisturbed for 14 days. This method originated in Austria 
and has given me such excellent results that I but rarely have 
to line fire a horse with chronically thickened tendons. It is 
vastly superior to the old method of simply rubbing in the 
blister, tying up the horse for 48 hours, washing it off and 
applying lard to the blistered parts, etc. 

What parts of the flexor pedis jjerforans are subject to tendin- 
itis ? 
In the heavy draught horse almost invariably the fibrous 
stay coming from the great posterior ligament of the carpus 
is involved ; more rarely is the analogous subtarsal ligament 
of the hindleg diseased. In this instance the perforans tendon 
itself is but little or not at §,11 involved. On the hindleg, ten- 
dinitis of the perforans either at the tarsal sheath — that is, 
right at the hock — or at the sheath just below the sesamoids, 
this tendon is subject to inflammatory changes. 

In luhat animal is tendinitis of the flexor pedis perforatus 
usually seen f 
Practically only in the saddle horse, simply because this 



DISEASES OF TENDONS 225 

teudon is taxed as it receives tlie full sliock by tlie weight of 
the body as the animal jumps or gallops. 

In wliat animal is tendinitis of the superior sesaraoidal liga- 
TTient usually seen ? 
More commonly in the saddle horse and trotter, for the 
same reasons that the perforatus becomes diseased. In those 
cases where this ligament gives way either partially or rup- 
tures entirely, the fetlock descends more or less, a condition 
termed by the sporting fraternity as " broken down tendons." 

Rupture of Tendons. 

What forms of tendon rupture are of interest ? 

Incomplete and complete rupture. 
What are incomplete tendon ruptures ? 

In these one or more tendon fibres, or possibly a little 
bundle of tendon fibres, may give way, these ruptures being 
microscopical in nature, and have just been fully dealt with 
xinder '* Tendinitis." 

What are the causes of complete tendon rupture ? 

They are the same as those of tendinitis, only in an exag- 
gerated form. Thus, excessive stretching is the most common 
traumatic canse. At the same time certain conditions predis- 
pose the animal to these ruptures, as contagious pleuro-pneu- 
monia, purpura hemorrhagica, or purulent tendovaginitis, and 
the not uncommon chronic inflammation of the navicular 
^ursa. 

Which are the more common tendon ruptures in animals ? 

Horse : Flexor pedis perforans and peforatus, suxDerior 
sesamoidal ligament and the flexor metatarsi. 

Cattle : Tendo Achilles and flexor metatarsi. 



226 PRINCIPLES OF VETERINARY SURGERY 

Dog : Tendo Achilles and flexor metatarsi. 
What are the symptoms of tendon ruptures 9 

They vary according to the tendon involved. The first 
thing is sudden lameness with more or less dorsal flexion of 
the phalangeal joints. In case the superior sesamoidal liga- 
ment is torn, the hoof bears weight with its whole plantar 
circumference, but the fetlock is let down — that is, exhibits 
excessive dorsal flexion. In case of the perforans, there is 
some dorsal flexion of the phalanges and the toe of the hoof is 
turned up a little, while in rupture of the perforans all three 
phalangeal articulations show decided dorsal flexion, weight 
being borne only by the heel of the hoof with the toe of the 
hoof distinctly elevated from the ground. In the earliest 
stages the point of division of the tendon can usually be felt, 
but is soon obscured by inflammatory swelling. 

What is the prognosis of these tendon ruptures ? 

Those of the forelegs, unless due to necrosis, which are 
usually incurable, heal in two to three months. 

What are the symptoms of rupture of the flexor metatarsi 9 

Sudden swinging-leg lameness ; the angle of the hock 
joint is wide open — that is, the tarsal articulation is extended 
to its fullest extent — while the stifle joint is decidedly flexed. 
The thigh totters so much that the two hocks may strike 
against each other. When the hand grasps the fetlock and 
brings the leg backward, no resistance is felt, as the flexor 
metatarsi is out of action at this moment \ the tendon achilles 
is strongly relaxed. 

What is the prognosis of rupture of the flexor metatarsi 9 

As a rule, recovery sets in in one to two months, leaving 
quite often a snappy gait. 



DISEASES OF TENDONS 227 

What are the symptoms of rupture of the tenclo achilles ? 

Severe sudden supporting-leg lameness. The animal is 
tinable to support weight, and all joints are excessively flexed. 
As long as no inflammatory swelling has set in, the flabby 
state of the tendon, as well as a gap in the tendon, can be 
detected. Passive movement of the hock permits of exagger- 
ated flexion of the joint. 

What is the prognosis of rupture of the tendo achilles ? 

In the horse and ox it is unfavorable, especially when a 
portion of the os calcis has been torn off, while in the dog a 
more favorable prognosis is permissible. 

How do you treat tendon ruptures ? 

Rest is essential in rupture of the superior sesamoidal lig- 
ament, flexor pedis perforans and perforatus ; a plaster paris 
dressing — or, probably just as good, a blister — is indicated. 
In rupture of the flexor metatarsi rest is all that is neces- 
sary. In rupture of the tendo achilles in the dog the tendon 
may be sutured or a plaster paris bandage applied. When the 
larger animals are to be treated for this rupture they must be 
placed in slings. 

What do you understand by luxation of the flexor pedis per- 
foratus ? 
A permanent separation of the fibrous cap of this tendoi^ 
from the posterior portion of the point of the os calcis. 

Oive the etiology of dislocation of the flexor pedis perforatus. 
Over-exertion and external violence. 

What are the symptoms of this luxation ? 

Entirely out of proportion is the slight lameness and the 
■unsteady, tottering gait. Each time the hock is extended the 



228 PRINCIPLES OF VETERINAEY SURGERY 

cap of the perforans will be seen to slip off the point of the os 
calcis, as a rule returning to its place as the leg is flexed. 
Swelling is usually pronounced, as this injury more frequently 
follows external traumatisms. 

W hat is the prognosis of this dislocation 9 

Almost invariably unfavorable, as it is almost impossible 
to retain the dislocated tendon. 

Tendon Necrosis. 

What are the causes of tendon necrosis 9 

It is the direct result of a purulent tendinitis. 

Is purulent tendinitis of primary origin in these cases ? 

Not usually, but is the result of purulent cellulitis of 

some neighboring organ from which the septic process spreads 

to the tendon. 

Why do tendons easily undergo necrosis ? 

Because their powers of regeneration and blood supply are 
limited. 

Which tendon is most frequently exposed to necrosis ? 

The plantar aponeurosis of the flexor pedis perforans of 
the horse. 

Where does the infection of the pilantar aponeurosis start 

from ? 
' Almost invariably there is at first, as the result of a nail- 
prick, a purulent cellulitis of the plantar cushion. From here 
the septic process extends to the navicular bursa and now the 
termination of the perforans becomes easily involved, as it is, 
so to speak, bathed in pus, there being a purulent bursitis; 
the continuous action of the pus producing necrosis of the 
tendon. 



DISEASES OF TENDONS 229 

Generally speaking, ivhat are the symptoms of necrosis of the 
plantar aponeurosis f 
Intense supporting-leg lameness, marked volar flexion of 
tlie phalanges, severe swelling in the hollow of the heel and of 
the frog. 

What does the necrotic tendon look like f 

The necrotic parts have a greenish yellow, sluggish 
appearance. 

What is the prognosis of necrosis of the plantar aponeurosis ? 
It is good, provided the animal is operated in time. Some 
operators give the time required for recovery from one to 
two months ; my experience as regards time is not as favorable, 
most of my cases necessitating from two to three months. 

Outline the treatment of tendon necrosis. 

It is strictly surgical, consisting in the total removal of 
frog and plantar cushion until the perforans tendon can be 
removed from the semi-lunar crest of the os pedis to the 
superior border of the navicular bone. Necrotic portions of 
the bursa and bone are removed, a drain made from the hol- 
low of the heel to the field of operation, the wound given an 
iodoform tampon dressing, the hoof bandaged, etc. 



230 PRINCIPLES OF VETERINARY SURGERY 



DISEASES OF SYNOVIAL, SHEATHS OF 
TENDONS. 

Inflammation of a Synovial Tendon Sheath (Tendo- 
vaginitis). 

Why are inflammatory processes of sy7iovial tendon sheaths 
and those of joints closely related 9 

Because in either instance a synovial membrane is in- 
volved. It may be classified as a serous membrane, its inner 
layer being lined -with endothelial cells, being analogous to 
the pleura and peritoneum. 

What forms of tendovaginitis are recognized ? 

According to its course it is acute or chronic, depending 
on the origin, primary or secondary, in regard to the cause, 
aseptic or traumatic, infectious or septic, according to the 
exudate, serous, fibrinous, purulent. 

From a iwactical point of vieiv, which forms are the most 
important ones f 
The acute and chronic, serous and fibrinous, and the acute 
purulent form. 

W hat is serous tendovaginitis ? 

Inflammation of the synovial sheath of a tendon with a 

serous exudate into the sheath. 

What arethe causes of serous tendovaginitis ? 

Usually mechanical irritations, as overwork (more rarely 
Contusions), or infectious diseases, as contagious pleuro- 
pneumonia, septicemia, etc.; in the latter usually more than, 
one tendon sheath is diseased, while in the former, as a rule, 
one synovial tendon sheath only exhibits pathological lesions. 



DISEASES OF SYNOVIAL SHEATHS OP TENDONS 231 

What are the symptoms of an acute tendovaginitis ? 

Pain on palpation and expressed by lameness with 
increased heat, more or less fluctuation and swelling along the 
sheath. 

What course does serous tendovaginitis tahe 9 

The parts either make a recovery by absorption of the 
serous exudate, or when resorption is tardy a condition com- 
monly termed a gall, or, scientifically speaking, a chronic 
tendovaginital dropsy, or in very aggravated cases, thickening 
of the synovial sheath (chronic fibrous tendovaginitis), pro- 
ducing more or less enlargement, sets in. 

What tendon sheath is preferably involved in chronic fibrous 
tendovaginitis ? 
The sheath common to the flexor pedis perforans and per- 
foratus, but right above the fetlock of the hind-legs, although 
in these cases the tendons themselves are also diseased. 

What is the prognosis of serous tendovaginitis ? 

Thos 3 due to simple traumatism are quite favorable, while 
those due to infectious diseases are less so ; again, those of 
the flexor tendons are less favorable than those of the extensor 
tendons. 

Why is the prognosis of tendovaginitis of the flexor tendons 
less favorable than those of the extensor tendons ? 
Because the sheaths of the extensor tendons are less ex- 
tensive and when diseased they do not interfere as much with 
the functions of the leg, as it would be in case the flexor ten- 
don sheath is diseased. 

Outline the treatment of acute serous tendovaginitis. 

Absolute rest, Priesnitz fomentations ; while the quickest 
way out of it is a blister. 



232 PRINCIPLES OF VETERINARY SURGERY 

What is purulent tendovaginitis ? 

An inflammation of a synovial tendon sheath with a pur- 
ulent exudate into the sheath. 

Wliat are the causes of purulent tendovaginitis ? 

1. Pus-producing bacteria are carried directly into the^ 
sheath from without (nail pricks, pitchfork jabs, etc.). 

2. The result of a contiguous septic inflammation ; for 
instance, in septic cellulitis of the plantar cushion, spreading 
into the navicular sheath. 

3. Of hematogenous origin, as in pyemia. 

What are the symptoms of a purulent tendovaginitis ? 

Severe lameness, high fever. The swelling rapidly spreads: 
"beyond the limits of the tendon sheath, and when of sufficient 
virulence the lymph vessels also swell ; when due to a per- 
forating wound, there is discharge of a straw colored, lumpy 
synovia ; later, abscesses form in the phlegmonous swellings ;. 
finally, the symptoms of septicemia or pyemia prevail. 

Outlirie the treatment of purulent tendovaginitis. 

As soon as there is reason to presume that pus is present 
in the sheath or the tendon necrotic, tlie knife claims its 
rights. Incisions, drainage and antiseptic irrigations and 
removal of the necrotic parts are indicated. 

Galls (Chronic Dropsy of Tendon Sheaths). 

What do you understand hy chronic dropsy of tendon 
sheaths ? 
A painless, non-inflammatory state of synovial tendon 
sheaths, thickened by connective tissue proliferation and dis- 
tention of the same by an accumulation of serous fluid. 



DISEASES OF SYNOVIAL SHEATHS OP TENDONS 

What are the causes of chronic dropsy of tendon sheaths ? 

Wind galls — as tliis condition is vulgarly termed — are the 
result of repeated mechanical irritations of the tendon sheath 
by the friction upon its walls from the gliding of the tendon; 
in other words, it is the sequel of a repeatedly occurring acute 
serous tendovaginitis. 

In what aiiimals is it common ? 

In all those doing continuously hard work ; therefore 
occurs usually in the adult, being more frequently seen in the 
bindlegs than in the forelegs. 

Which are the most imjjortant galls of the sheaths of the 
flexor tendon 9 

Foreleg : The perforans and perforatus, as they pass 
through the carpal sheath, are enveloped by a synovial sheath, 
which, when distended, appears as a longish swelling, as far 
as four inches above the carpus, and runs down to the upper 
third of the metacarpal bones. 

Chronic distention of the metacarpo-phalangeal sheath, 
which also forms an envelope common to the perforans and 
perforatus at the fetlock, represents the so-called wind galls. 
It forms a longish swelling, which, above the fetlock, is 
divided into two swellings by the tendon extending to the 
lower third of the metacarpal bones. Below the fetlock the 
swelling appears flattened and is by no means as often seen as 
the upper swelling. 

Hindleg : The flexor pedis perforans is enveloped by a 
large synovial sheath occupying the internal and posterior 
surface of the tarsal articulation ; that portion on the internal 
face of the joint, when distended, appears as a globular en- 
largement of variable size. 



234 PRINCIPLES OF VETERINARY SURGERY 

Tlie perforatus lias a synovial slieath. beginning at the 
point where the perforatus tendon crosses the gastrocnemius 
tendon and extending as far as the os calcis. When distended 
it appears as a swelling of variable size on either side of the 
tendo achilles, just above the point of the os calcis. 

At the fetlock chronic distention of the sesamoidal sheath 
enveloping the perforans and perforatus is common. It is 
much more frequent in the hind legs and more prone to 
exhibit fibrous thickening in the wall of the sheath, represent- 
ing, pathologically speaking, a chronic fibrous tendovaginitis, 
or, as it is vulgarly called, a hardened wind gall. 

Which are the more common galls of the sheaths of the exten- 
sor tendons ? 

Forelegs : The distended sheath of the extensor suffraginis 
starts three to four inches above the carpus on the outside of 
the forearm and runs downward as far as the anterior face of 
the carpus. 

The sheath of the extensor pedis, which is rarely seen dis- 
tended, begins about six inches above the carpus, runs over 
its anterior face to the upper portion of the metacarpus. This 
tendon rests upon a mucous bursa of the metacarpus or meta- 
tarsus, occupying the anterior face just above the fetlock joint, 
which may attain the size of an egg. 

The distended sheath of the extensor metacarpi magnus 
occupies the middle of the anterior face of the carpus, but does 
not go as far up or down as the one of the extensor pedis. 

The distended sheath of the extensor metacarpi obliquus 
begins near the outside and about three inches above the car- 
pus, running obliquely down and inward over the anterior 
face of the carpus to the head of the inner small metacarpal 
bone. 



DISEASES OF SYNOVIAL SHEATHS OF TENDONS 235 

Hind leg : A common sight is the distended sheatli of the 
peroneus tendon, found at the external and lower part of the 
hock. 

What is the prognosis of chronic dropsy of the synovial ten" 
don sheaths ? 

This condition, as a rule, does not lame the animal, repre- 
senting, therefore, more a blemish than anything else. Tak- 
ing it all around, one can safely say that chronic dropsy of 
the tendon sheath is incurable. A cure here and there occurs. 

Outline the treatment of dropsy of the synovial sheaths. 

To the cautious, conservative surgeon these synovial 
sheaths, when chronically distended by a serous exudate, are 
a sort of noli me tangere — at least with the knife — this refer- 
ring especially to the sheaths of the flexor tendon, simply be- 
cause of the possibility of a septicemia or pyemia following 
the opening of such a sheath. Practical experience has shown 
innumerable times that the opening of the synovial sheaths, 
even when aseptically done, is not without danger, as it is 
very difficult to keep an aseptic dressing in place ; neverthe- 
less, horses have been operated successfully by this method. 
Puncturing the sheath with the needle-pointed firing iron also 
is risky. The injection of a watery solution of iodine, while 
less dangerous, is by no means reliable. Finally, puncture or 
line firing or blisters are of questionable value, almost invari- 
ably failing. 

The lameness of the so-called hard galls, the result of dis- 
ease of the perforans tendon and chronic fibrous changes of 
the tendo-vaginal sheath, are frequently helped by line firing 
plus blistering. Should this fail, tibial neurectomy will give 
fair results. 



236 PKINCIPLES OF VETERINARY SURGERY 

DISEASES OF THE MUCOUS BURSA. 
Bursitis. 

What do you understand by bursitis f 

Inflammation of a mucous bursa. 
What forms of bursitis are recognized ? 

They are classified in the same way as diseases of the ten- 
don sheaths or joints. 

Which bursitis is of practical interest ? 

Of the various bursse, that of the olecranon and os calcis, 
either as an acute serous or acute purulent bursitis, are of 
special and everyday interest to the practitioner. 

What other bur see are quite often inflamed ? 

The navicular bursa, as in navicular hoof disease ; tha 
trochanteric bursa, as in lameness due to inflammation of the 
tendon and tendon sheath of the middle gluteous muscle; also 
the intertubercular bursa lodged in the bicipital groove of the-- 
humerus for the benefit of the flexor brachi, which, when dis- 
eased, gives rise to marked shoulder lameness. 

What are the causes of acute serous bursitis 9 

Usually some external traumatism, as contusions, pres- 
sure, blows. 

W hat is the most common cause of olecranian bursitis ? 

Capped elbow, as this condition is commonly termed, is. 
frequently seen in horses, which, for some reason or other, lie 
down a great deal (those afflicted with chronic lameness, as 
pododermatitis, navicular arthritis, etc.). In this instance 
the region of the olecranian bursa is bruised by the pressure 
of the shoe. 



DISEASES OP THE MTJCOUS BURSA 237 

^WMcli is the most common cause of calcanian bursitis ? 

This condition, also termed capped hock, is frequently 
-seen in horses which, as a vice, bang their hocks against the 
stall partition. When backing a horse, and the hold back 
part of the harness is too long, the animal will strike the 
point of the os calcis frequently against the whiffletree and 
thus bruise the bursa. 

What are the symptoms of acute bursitis ? 

There is a swelling of variable consistency, possibly fluc- 
tuating or rather firm, more or less edema of the parabursal 
tissue (tissue surrounding the bursa), but little pain on palpa- 
tion. 

•Outline the treatment of acute bursitis. 

The first thing consists in the removal of the direct cause, 
such as padding the stall partition for a kicker, changing the 
shoe, giving plenty bedding or a box stall, etc. Wherever 
possible, try to absorb the serous fluid and avoid the opening 
of the distended bursa while acutely inflamed, as a purulent 
l)ursitis, which is tedious to treat, is almost sure to follow an 
incision. 

Purulent Bursitis. 

TF hat is purulent bursitis ? 

An inflammation of the bursa with pus formation. 

l^hat are the causes of purulent bursitis ? 

It may be the consequence of incising a serous bursitis, 
pus germs entering the bursa through the wound, or it may 
follow a contusion sufiiciently severe to destroy the solution 
of continuity of the overlying skin with a wound extending 
into the bursa. 



238 PRINCIPLES OF VETERINARY SURGERY 

What are the symptoms of a purulent bursitis 9 

There is decided swelling, septic cellulitis of the j)ara- 
"bursal tissue, with a discharge of pus. 

Outline the treatment of purulent bursitis. 

Split the swelling from the center downward and intro- 
duce tampons saturated with a two to three per cent, chloride 
of zinc solution for two to three days ; after that employ anti- 
septic irrigations. I have had splendid results in the treatment 
of capped elbow by making a regular sieve out of the swell- 
ing by running the finest platinum point of the thermocautery 
through the skin deeply into the infiltrated parabursal tissue, 
having the holes made by the red hot point about three- 
quarters of an inch apart. 

Chronic Dropsy of the Mucous Bursa. 

What are the causes of hygroma of mucous bursa 9 

When the serous or serofibrinous fluid in the bursa is not 
absorbed a chronic bursitis results. When now mechanical 
irritations, such as pressure from a shoe or kicking, etc., are 
allowed to continuously act upon the chronically diseased 
"bursa, a hygroma or chronic dropsy of the bursa is the result.. 

W hat changes take place in the bursa before it becomes a. 
hygroma 9 
The walls of the bursa and the parabursal tissue undergo 
chronic fibrous changes leading to more or less extensive 
thickening and induration of the walls, forming a firm con- 
nective tissue capsule. 

Pathologically speaking, what process takes place 9 

A chronic fibrous bursitis and chronic parabursitis. 



DISEASES OF THE MUCOUS BUESA 239 

Describe the hygroma of the olecranium bursa. 

This condition, commonly called shoe boil, represents a 
globular, circumscribed, painless, hard, more or less pendu- 
lous mass at the point of the elbow. It is very common in the 
horse and is also seen in the larger breed of dogs. 

Describe the hygroma of the calcanian bursa. 

This is represented by a somewhat elastic, painless, cir- 
cumscribed, globular swelling at the point of the os calcis, 
and may possibly be confounded with other pathological 
products peculiar to this part. 

How can you differentiate the calcanian hygroma from patho- 
logical states simulating it ? 

A discussion of this subject does not belong to a work 
on general surgery (look up Mohler's " Special Surgery '' for 
that purpose). 

Outline the treatment of bursal hygroma. 

The practically fibrous mass of an olecranian hygroma 
is either ligated en masse or allowed to drop off, of course 
employing proper antiseptic measures at the same time. This 
form of treatment is not very desirable. Very large ones, 
when a removal is required, are best excised, while those as 
large as two fists can be puckered up to almost nothing by 
puncturing them with the thermocautery as described under 
" Outline the treatment of purulent bursitis." 

Inflammation of tlie Muscles (Myositis). 

Depending on the cause, ivhat forms of myositis are recog- 
nized ? 
Rheumatic, traumatic, infectious and parasitic. 



240 PRINCIPLES OF VETERINARY SURGERY 

What is a specific inyositis ? 

The inflammation of a muscle due to a special bacillus or 
l^arasite. 

Give an example of specifi^c myositis. 

When due to the trichina spiralis, it is termed trichinous 
myositis (m^yositis tri chinos a,); when due to the ray fungus, 
Tnyositis actinomycotica ; when due to the bacillus of tubercu- 
losis, it is termed myositis tuberculosa, etc. 

'Depending on the course, what forms of myositis are knoivn ? 
Acute and chronic. 

According to the character of the exudate, what forms of m^yo- 
sitis are known ? 
Serous, purulent and their subvarieties. 

Depending on the character of the inflammation, what forms 
of Tnyositis are known ? 

Interstitial, parenchymatous. 
What do you understand by an interstitial 'inyositis ? 

It is a myositis of chronic nature accompanied with con- 
nective tissue proliferation mainly in the internal perimysium, 
which gradually replaces the muscular substance. 

What is a parenchymatous myositis 9 

A myositis involving the muscular substance proper 
(primitive muscle fibers, muscle columns and muscle cells). 

According to the origin, what forms of myositis are knoivn ? 

Primary or secondary (also termed metastatic). 
Give some examples of secondary Tnyositis. 

Metastatic myositis is represented by tubercular myositis, 
actinomycotic myositis, equine streptococcus distemper, etc. 



DISEASES OF THE MUCOUS BURSA 241 

What foi'ms of myositis are of practical interest to the sur- 
geon ? 

1. Traumatic serous myositis. 

2. Purulent myositis. 

3. Interstitial myositis. 

4. Ossifying myositis. 

5. Muscular rheumatism. 

TRAUMATIC SEROUS MYOSITIS. 

Jn what animal is it most frequently seen 9 

In the horse. 

What are its causes 9 

Contusions, as in runaways, railroad transportation, over- 
■extension, contiguous inflammations. 

What course does traumatic myositis usually take 9 
An acute course ; more rarely a chronic one. 

What changes take place in a muscle in acute serous 
myositis ? 

As the result of the inflammation a serous or hemorrha- 
gic exudate invades the external and internal perimysium, to 
l)e replaced by cellular infiltration, as in inflammation of 
other organs. The muscle fibers are either left undisturbed 
or undergo granular and fatty degeneration, which, of course, 
terminates their life period. In those cases followed by 
resolution — that is, prompt recovery — the contractile ele- 
ments remain intact, while in those cases taking a chronic 
course the connective tissue of the perimysium proliferates 
gradually, crowding the contractile substance out of ex- 
istence. 



242 PRINCIPLES OP VETERINARY SURGERY 

Which muscles are especially exposed to traumatic myositis ? 

In the liorse, the mastoido-humeralis, on account of its 
prominent position, giving rise to a marked shoulder lame- 
ness. In swine and cattle, when shipped by rail, and espe- 
cially when an undue number is put into a car, contusions are 
common, especially of the muscles of the shoulder, croup and 
breast. 

What are the symptoms of traumatic serous myositis ? 

A circumscribed painful area, with more or less swelling, 
impaired function and increase of temperature of the parts. 

Outline the treatment of traumatic serous myositis. 

Rest, hot applications ; later, stimulating liniments where 
the rubbing of the parts — that is, massage — is the most impor- 
tant therapeutic point ; blisters. 

PUKULENT MYOSITIS. 

W hat are the causes of purulent m,yositis ? 

This form starts with an infection of a wound of the mus- 
cular tissue, either leading to a phlegmonous myositis or 
abscess formation. 

What changes take place in the muscular tissue in purulent 
myositis ? 

The perimysium becomes necrotic, the adjoining fascia 
may undergo necrosis and the muscular fibers die ; the necrotic 
area varying in extent according to the intensity of the infec- 
tion. Thus results either a diffused septic cellulitis or simply 
an abscess. 

What important sequels are lihely to follow purulent myositisf 
Septicemia, pyemia, fistulse, abscess. 



DISEASES OF THE MUCOUS BUESA. 24^ 

Give a common example of purulent myositis. 

The so-called shoulder abscess of the horse. 
How is this shoulder abscess formed 9 

The large, circumscribed globular swelling, at times the 
size of a man's head, either develops in the mastoido humer- 
alis at the point of the shoulder, or in the lymph glands right 
below the muscle, but always involving it. It seems that two 
factors are actively concerned in the production of this 
abscess. Pathologically speaking, it represents a purulent 
myositis, the pus being enclosed by a fibrous capsule of vari- 
able thickness, which capsule again is the result of an inter- 
stitial myositis. Contusion and subsequent infection with 
pus-producing germs are essential etiological factors. It is 
my experience that the vast majority of these deep and 
chronic abscesses are found on the right side of the horse, 
which supports the assertion that bruising is necessary for 
the entrance of bacteria belonging to the streptococci and 
staphylococci, and at times botryomyces. Most likely the 
contusion lowers the vitality of the tissues, the germs being 
carried into them by the lymph channels, where they develop 
either in the mastoido humeralis, producing a cellular infil- 
tration and next an abscess, or the germs are deposited in the 
lymph glands below the muscles, in which case there is a 
primary chronic suppurative lymphadenitis with a secondary 
chronic interstitial myositis. 

Name some diseases where multiple metastatic muscle 
abscesses are seen. 
In the streptococcus distemper of the horse and in 
pyemia. 

Outline the treatment of purulent myositis. 

Incise the parts and secure drainage, and employ anti- 



'244 PRINCIPLES OF VETERINARY SURGERY 

septic measures. In tlie shoulder abscess do not waste time 
with external applications, but slit the indurated muscle open 
and if necessary open the pus cavity with a boring motion of 
the extended finger. 

INTERSTITIAL MYOSITIS. 

What is interstitial Tnyositis ? 

It represents a chronic inflammatory process with con- 
nective tissue proliferation mainly of the internal perimysium, 
which gradually replaces the contractile substance, as a result 
of which the muscle becomes shorter and harder. 

What are the causes of interstitial myositis ? 

The etiology of this myositis is still a little obscure. It 
seems that parasites and bacteria play an important role. 

Where is it commonly seen ? 

In chronic muscular rheumatism, in traumatic purulent 
states of the muscles, in specific infection, as actinomycosis 
.and muscular atrophy, etc. 

OSSIFYING MYOSITIS. 

What is an ossify iiig myositis ? 

A myositis of rare occurrence, where the connective tissue 
— that is, the perimysium — is gradually changed into bony 
tissue, which, as the result of its development, causes degen- 
eration and atrophy of the muscular fibers. 

How is this ossifying myositis explained ? 

There are two forms. In the primary ossifying myositis, 
one deals with a neoformation ; in other words, an osteoma — 
that is, a bony tumor — is directly developed. In secondary 
ossifying myositis, the ossification of the perimysium is a sec- 
ondary process, there being first the formation of exostoses at 



DISEASES OF THE MUCOUS BURSA 245 

the bony origin or insertion of such a muscle. It seems that 
the connective tissue constituents of a muscle which are near 
bony insertion, and where the osseous changes are mainly 
observed during their original development, are endowed 
with periosteal-like properties, as the bony process is identical 
with bony formation, such as is seen to come from the peri- 
osteum. 

In which animals has ossifying myositis heen observed ? 
Horses, dogs and swine. 

What is the treatment ? 

None ; the disease is incurable. 

MUSCULAR RHEUMATISM. 

What is muscular rheumatism ? 

An acute serous myositis at first, with a strong tendency 
toward chronicity, in which case it leads to a chronic inter- 
stitial muscular inflammation. 

What is the cause of rheumatic Tnyositis ? 
Mainly exposure to cold and damp. 

What changes take place in the affected tissues f 

In acute muscular rheumatism the changes peculiar to 
serous myositis, while in the chronic form those accompanying 
interstitial myositis are seen. 

What animals are mainly subject to rheumatic myositis ? 
Dogs, cattle and horses. 

What muscles are more frequently involved ? 

The mostoido humeralis, the cervical and lumbar and 
gluteal muscles and intercostal muscles. 



246 PRINCIPLES OF VETERINARY SURGERY 

W hat are the symptomis of rheumatic myositis ? 

lu torticollis, tlie cervical muscles being involved, the 
neck is lield to one side, all movements avoided ; palpation is 
painful. In case the mastoido humeralis is diseased, there is 
distinct shoulder lameness, the animal improving on exercise. 
In pleurodynia, where the intercostal muscles are inflamed, 
there is dyspnoea, the animal grunts when the intercostal 
spaces are palpated, while rheumatic myositis of the lumbar 
muscles and those of the gluteal region causes a stiff and pain- 
ful gait, especially painful on palpation in dogs. 

What is peculiar to rheumatic myositis ? 

It has a tendency to shift from one place to another, is 
strongly recurrent and tends to chronicity. 

Outline the treatment of rheumatic myositis ? 

In acute cases, warm, moist applications, later stimulating 
applications aiid sodium salicylate internally. In chronic 
cases in the horse, hypodermic injections of veratrin are indi- 
cated. 

Bupture of Muscles. 

In what animals is the tearing of muscles mainly observed 9 

Horse and ox. 
W hat are the causes 9 

As a result of previous diseases, the muscular fibers may 
have undergone granular degeneration, thus weakening the 
muscle and predisposing it to spontaneous lacerations (same 
a.s seen in tendons). Direct causes are strong traction on a 
muscle, undue and sudden unopposed contractions, blows. 

To what extent do muscles rupture ? 

All the way from a slight tear to complete pulpification. 



DISEASES OF THE MUCOUS BURSA 247 

Which muscles are mainly ruptured ? 

Most commonly tlie flexor inetatarsi, next the abdominal 
muscles, as the rectus obliquus and transversus abdominis ; 
next, the triceps femoris, the gluteal muscles, gastrocnemius, 
biceps femoris, flexor brachii, mastoido humeralis. 

Outline the treatment of rupture of muscles ? 

Rest ; and for the benefit of a restless owner, some exter- 
nal application. 

How does an aseptic muscle rupture heal ? 

The exuded blood is absorbed. Proliferations take 
l^lace in the external and internal perimysium, filling the gap. 
This scar tissue retracts more or less in due time, and a depres- 
sion can be seen and felt in the muscle at the point of former 
rupture. 

What symptoms does a ruptured muscle produce ? 

This depends entirely upon the muscle involved. Thus, 
rupture of the abdominal muscles is followed by a hernia, 
rupture of the muscles of the locomotory apparatus gives rise 
to lameness. In the earlier stages palpation may locate a dis- 
tinct gap between the ends, or in cases of some standing this 
is hidden by an extravasation of blood, swelling and pain, 
and impaired or lost function. 

Which symptoTns does rupture of the flexor metatarsi give 
rise to ? 

The same as that of its tendon, which see. Prognosis is 
favorable ; the process of healing requires about one month, 
to six weeks. 
What symptoms does rupture of the gastrocnemii produce ? 

The same as that of their tendon, which see. The prog- 
nosis is unfavorable ; complete recovery is rare. 



248 PRINCIPLES OF VETERINARY SURGERY 

What symptoms does rupture of the triceps femoris produce T 
Being the mainstay of tlie femoro tibial articulation, the- 
rupture of this compound muscle no longer holds the stifle 
up and the animal acts as in ^Daralysis of the crural nerve as 
it is seen in hemoglobinemia (azoturia) ; that is, it gives way 
in all articulations of the leg. 

What symptoms does rupture of the mastoido humeralis 
cause ? 
Swinging-leg lameness, being usually the result of some- 
contusion ; infection of that place often takes place, followed 
hy abscess formation at the site of rupture. 

What syviptoms does rupture of the abdominal muscles pro- 
duce 9 
It is followed by a hernia of variable size. 

Atrophy of Muscles. 

Give the etiology of muscular atrophy. 

Generally speaking, the true muscular elements may 
decrease in size and numbers as the result of disuse, articular 
diseases or interference with the nerve supply of the affected 
muscle, or of a generally depraved state of the blood. 

What forms of muscular atrophy are of interest ? 

Simple atrophy, degenerative atrophy, lipomatous 
atrophy. 

What do you understand by simple atrophy ? 

A diminished size of muscles due to a decrease in size and 
numbers of the muscular fibers, but without degenerative 
changes of the fibers. 



DISEASES OF THE MUCOUS BURSA 249 

What are the causes of simple atrophy ? 

In certain chronic lamenesses, tlie result of articular dis- 
eases, as in spavin or ringbones, wasting of the muscles 
of the croup or shoulder is common. In this instance 
muscles atrophy on account of a reflex disturbance of the 
trophic nerves, and, second, on account of inactivity — that 
is, enforced quietude of the affected muscle. 

Can you give a positive testimony as to the length of time a 
part is atrophied ? 

In the vast majority of cases of muscular wasting, it is 
impossible to conscientiously state the age of an atrophy. It 
can only be approximated, which, of course, is of little value 
from a forensic point of view. 

Why can you not give a positive ansiver as to the age of an 
atrophy ? 

Because the muscles of some animals waste away more 
quickly than those of others, because the atrophy becomes 
more quickly evident the fatter the animal, and the greater 
the lameness. Marked atrophy of muscles in fat animals is 
sometimes seen to take place in two to four weeks. 

DEGENERATIVE ATROPHY. 

What is degenerative atrophy ? 

A decrease in size and numbers of the muscular elements 
with destruction of the contractile substance and fatty degen- 
eration of the same. 

Which are the common causes of degenerative muscular 
cdrophy 9 

Peripheral nerve paralysis and nutritive disturbances 
due to serious infectious diseases. 



250 PEINOIPLES OP VETEEINAKY SURGEEY ! 

Give some examples of degenerative atrophy. 

Atrophy of the spinatus muscles follows paralysis of the 
suprascapular nerve ; paralysis of the radial nerve leads to 
wasting of the triceps extensor of the forearm. Paralysis of 
the recurrent laryngeal nerve in some instances causes 
arytenoid hemiplegia and atrophy (roaring), while in the 
hindleg paralysis of the crural nerve produces atrophy of the 
triceps femoris. Atrophy of muscles due to inflammatory 
processes producing serious nutritive disturbance find their 
best example in azoturia (hemoglobinuria). 

LIPOMATOUS ATROPHY. 

What do you understand hy lipomatous atrophy f 

This is the only form of atrophy where the volume of the 
muscle increases in size, explained as follows : In the connec- 
tive tissue between the primitive muscular fibers an excessive 
amount of adipose tissue develops, which, by its pressure, 
leads to atrophy of the contractile substance. It is the large 
amount of fat thus formed which increases the size of the 
muscle, while in reality the muscular elements proper are 
being more or less destroyed. 

Give an example of lipomatous atrophy. 

Commonly seen in animals fattened for the market. It 
is a well known fact that fat pigs or cattle are unable to stand 
any exertion, simply due to the depraved state of the muscu- 
lar system. 

Outline the treatment of muscidar atrophy. 

In simple atrophy a nourishing diet with regular work, 
hand rubbing and possibly stimulating applications or injec- 
tions of strychnine or veratrine are indicated. In degenera- 
tive atrophy the contractile substance is destroyed and not 



DISEASES OF APONEUROSES 251 

to be replaced. Here the treatment consists in preventing 
further progress of the degenerative changes, by producing a 
compensatory hypertrophy of the contractile elements still 
present. The best results in cases of recent atrophy are intra- 
muscular injections of a sterile, saturated, aqueous, NaCl solu- 
tion. In chronic cases, injections of an aqueous, saturated 
solution of bichloride of mercury gives excellent results ; in 
the latter instance excessive swelling, which occasionally fol- 
lows it, is controlled by internal doses of potassium iodide. 
Injections of turpentine are often followed by violent symp- 
toms and are best omitted. 



DISEASES OF APONEUROSES. 

What role do the diseases of aponeuroses plmj in surgery ? 

They play a very important part, giving rise to long-lived 
fisutlsB when undergoing purulent changes ; they act as a 
support to the muscles which they cover, and when torn a so- 
called muscular hernia is the result. In cattle, dislocation of 
the biceps femoris is at times the result of an aponeurotic 
rupture. Having a limited blood and nerve supply, and 
being composed of fibrous tissue, they are very liable to 
necrosis, their vitality being small. Their structure itself 
does not render them liable to inflammatory processes ; thus 
they act as guards against contiguous inflammations to the 
muscles below or above them, but this very firmness also 
causes them to permit septic inflammatory processes to become 
diffused, phlegmonous processes spreading readily in the 
space formed between the aponeuroses, which space is termed 
the subfacial space, and any inflammatory process taking 
place in this subfacial space is known as subfacial cellulitis. 
Otherwise the aponeurosis is actively concerned in the circu- 



252 PRINCIPLES OF VETERINARY SURGERY 

lation of tlie blood and lymph, producing a sort of pumping 
■effect by their contractions and relaxations. 

Necrosis of Aponeuroses. 

What are the causes of aponeurotic necrosis ? 

Intermuscular and subfacial purulent cellulitis, usually^ 
the result of purulent wounds of muscles. 

Why are aponeuroses subject to prolonged necrosis f 

Because their powers of regeneration are very limited j 
because they are deeply located, rendering drainage difficult, 
thus allowing them to be continuously exposed to the irritat- 
ing action of pus; because they are very firm, rendering- 
decided resistance to exfoliation of the necrotic part; and, 
finally, because they are extensive, offering a large area ta 
infection. 
To what extent are aponeuroses usually necrotic ? 

More commonly the necrotic process is circumscribed, but 
diffused necrosis is also seen. 

What are the symptoms of aponeurotic necrosis? 
A fistulous tract leads to the necrotic part. 

Which anatomical regions are common examples of aponevr- 
rotic necrosis f 
The poll (poll evil), fistulous neck and withers, fistulse- 
about the croup. 

Outline the treatment of aponeurotic necrosis ? 

Caustic injections have their advocates, but I do not 
advocate them. Lately, protargol has given me very good 
results, but above all stands the knife. Of course the knife- 
shy surgeon will be disappointed. Deep and long incisions, 
utter removal of everything which is necrotic, must be the 
battle cry, with subsequent drainage and antiseptic treatments 



DISEASES OF NERVES • 253 

Rupture of Aponeuroses. 

TV hat are the causes of aponeurotic rupture 9 
External traumatisms, as blows, kicks, etc. 

What are the symptoms of aponeurotic rupture 9] 

When the aponeurosis covering a muscle is torn by au 
external assault, a portion of the muscle covered by the apo- 
neurosis bulges out through the rent in the aponeurosis, pal- 
pation showing the firm edges of the split in the aponeurosis 
with the soft muscular substance in the center. 

Retraction of the Tibial Aponeurosis. 

What importance is attached to retraction of the tibial apo~ 
neurosis 9 
By some authorities retraction of the tibial aponeurosis 
is given as the cause of stringhalt. 

Does this assertion prove true 9 

By no means. Some stringy horses make a recovery 
"when section of the aponeurosis is made, especially when 
combined with section of the peroneal tendon. Others do 
well when the internal lateral ligament of the patella is cut ; 
^again, other authorities attribute stringhalt to nervous dis- 
eases. 

What do you understand by pseudo stringhalt 9 

False or symptomatic stringhalt represents a snatchy 
movement of the hindlegs of horses, accompanying such con- 
ditions as eczematous or gangrenous dermatitis (scratches), 
xingbone, spavin, coronary caulking, etc. 



254 PBINCIPLES OF VETERINARY SURGERY 



DISEASES OF NERVES. 
Paralysis. 

What do you understand hy paralysis of a nerve 9 

Complete cessation of tlie functional activity of the nerve.. 

What do you understand hy paresis ? 

Impaired functional activity of a nerve. 

According to the origin, what forms of paralysis are recog- 
nized ? 
When originating in the hrain, it is termed cerebral paral- 
ysis ; when in the spinal cord, it is called spinal paralysis ; 
when originating in a nerve trunk — that is, the nerve after it 
leaves the spinal canal — it is known as peripheral paralysis. 

According to the extent of the paralyzed area, what forms of 
paralysis are given ? 
In hemiplegia, one side of the body is paralyzed ; in. 
paraplegia, both sides are affected ; in monoplegia, a muscle 
or set of muscles, or a single leg, is paralyzed. 

What psychological facts are of special interest in nerve 
paralysis ? 
A voluntary contraction of a muscle requires, first, a 
motor impulse generated in the psychomotoric centers in the 
gray matter of the cerebral cortex ; this is conducted down- 
ward by the motor fibers, which decussate at the medulla 
oblongata ; that is, those fibers originating on the right side 
cross over to the left side and vice versa (which explains the 
fact that a hemiplegia, for instance, affecting the right side 
of the body finds its active cause in some pathological state of 
the left side of the brain). After decussating, the motor 



DISEASES OF NERVES 255 

fibers run downward in the lateral columns of the spinal cord, 
a great many of them becoming connected with the large mul- 
tipolar cells in the inferior horns of gray matter ; from here 
the motor impulse is transmitted by the inferior root, which, 
together with the superior root, the sensory one, constitutes the 
spinal nerve leading to the skin, muscles or viscera. 

Into what two large divisions may the motor tract he subdi- 
vided ? 

1. The cerebro-spinal tract — that is, the one beginning in 
the motor centers of the cerebrum and ending, so to speak, in 
the large multipolar cells of the inferior gray horn. 2. The 
peripheral tract — that is, the one beginning with the inferior 
and superior root and extending to the periphery — that is, the 
muscles. 

What are the causes of paralysis f 

Peripheral paralyses are usually due to some traumatism, 
as contusions, lacerations, stretching; cerebral and spinal 
paralyses more generally are due to cerebral and spinal 
diseases. 

What general symptoms does a paralyzed muscle exhibit? 

Voluntary contractions are either impaired (paresis) or 
impossible (paralysis). As a rule, the paralyzed muscle is 
flabby and does not oppose passive movements. But the par- 
alyzed muscle may be reflexly stimulated and appear in a state 
of continuous contraction. Usually the paralyzed muscle 
atrophies more or less rapidly. 

What deduction can you mahefrom reflex movements taking 
place through the spinal cord ? 
By artificially producing reflex movements of muscles 
one can determine the condition of the various segments of 
the spinal cord. 



256 PRINCIPLES OF VETERINARY SURGERY 

How is the more or less rapid atrophy of a paralyzed rauscle 
explained ? 

When the functional activity of the motor tract is inter- 
rupted before the motor libers connect with the large multi- 
polar cells in the inferior gray horn of the sjDinal cord, the 
nutrition of the paralyzed muscle is only disturbed by the in- 
activity of that muscle ; in other words, there is an inactivity 
atrophy and no degenerative changes in the muscular fibers 
themselves, simply because the trophic motor ganglia — that 
is, the multipolar cells in the gray horn — are not disturbed in 
their nutritional influence which they exert over the nerve 
and muscle. But as soon as these ganglia themselves are dis- 
eased, or the active cause of the paralysis lies back of them, 
thus interrupting their nutritional influence over the nerve 
and muscle, a rapid degenerative atrophy sets in. 

Of luhat value are these points in regard to the prognosis of a, 

paralysis ? 

In inactivity atrophy, the nutrition of the nerve and 
muscle not being interfered with, restitution under certain 
circumstances is possible; while in those cases of paralysis 
with destruction of the trophic elements of the nerve and 
muscle, permanent and irreparable damage renders the prog- 
nosis unfavorable, as far as the muscle and nerve are con- 
cerned. 

What do you understand hy the reaction of degeneration 9 

A modification in the electric properties of paralyzed 
nerves and muscles. 

TF hat do you understand by the electrical properties of rrtus^ 
cles and nerves ? 
. Healthy nerves and muscles, when exposed to electric 
stimulation, respond to it in a precise manner. When dis- 



DISEASES OF NERVES 257 

eased, the electric conductivitj'' of nerves and tlieir muscle 
endings produces alterations in their reactions to electric 
stimuli. 

Of ivhat value is the reaction of degeneration to the surgeon ? 
It is very important in the diagnosis and prognosis of a 
paralysis. 

What forms of electricity are used to test electric properties of 
muscles f 

The induced or faradic current and the constant or gal- 
vanic current. 

What does the presence of the reaction of degeneration indi- 
cate ? 
It points positively to structural changes in the diseased 
parts. 

How soon does a paralyzed nerve lose its electric excitability ? 
In about fourteen days. 

How soon does a muscle lose its electric excitability 9 

Muscles soon cease to react to the faradic current, while 
"when exposed to the galvanic current their excitability is at 
first increased, to lose itself in four to eight weeks — that is, 
the muscular contraction becomes slower and slower at the 
make and break of the constant current (as the current is 
allowed to pass or is interrupted). 

Upon what features is the diagnosis of cerebral paralysis 
based ? 

The paralyzed area is, as a rule, extensive — hemiplegia ; 
but may be a monoplegia, only involving one cranial nerve; 
then reflex action is present and degenerative atrophy is 
wanting. 



258 PRINCIPLES OF VETERINARY SURGERY 

What are the essential features of a spinal paralysis ? 

As a rule, "botli sides of the body are involved (paraplegia). 
Reflex movements may be absent, excessive or normal. 
Atropby of the affected muscles may be wanting or highly 
developed (depends upon the seat of the active cause ; for this 
reason the reaction of degeneration may or may not be 
present). 

Which are the peculiarities of peripheral paralysis ? 

As a rule, certain groups are involved (monoplegia). Re- 
flex movements soon cease to exist, degenerative atrophy of 
the paralyzed muscles is common ; the reaction of degenera- 
tion is present. 

What points do you consider in establishing the seat and 
cause of a paralysis ? 
The development, course and extent of a paralysis. 

What deductions can you make from the development of a 
paralysis ? 
When developing suddenly it suggests a traumatism, 
while slow development indicates a tumor or strangulation of 
the nerve by scar tissue. 

Which peripheral paralyses are of special surgical interest ? 

1. Suprascapular nerve paralysis. 2. Radial paralysis. 
3. Crural paralysis. 4. Facial paralysis. 5. Paralysis of the 
motor branch of the trigeminal nerve. 

W hich are the peculiarities of suprascapular nerve paralysis ? 
At the moment the leg supports weight the scapula is 
suddenly jerked away from the thorax. Later follows 
atrophy of the antea and postea spinatus and teres major. 
The prognosis is unfavorable, as most cases do not recover. 



DISEASES OP NERVES 259 

What are the peculiarities of radial paralysis ? 

Complete inability to support weiglit with the leg. The 
paralyzed triceps extensor appears flabby and atrophies later. 
Prognosis is favorable. 

What are the peculiarities of crural nerve paralysis ? 

Since the triceps femoris is paralyzed the leg breaks 
down in the attempt to support the weight of the body. 
Later the muscle atrophies materially. Those due to trumat- 
isms have a favorable prognosis. 

What are the peculiarities of facial paralysis ? 

The paralyzed muscles are drawn over to the other side of 
the face by their antagonists ; food accumulates between the 
cheeks and teeth ; the upper eyelid hangs down. 

What are the peculiarities of paralysis of the motor branch of 
the trigeminal nerve 9 
Apprehension of food is difficult, the muscles concerned 
in mastication are paralyzed and atrophied, there is ptyalism, 
food accumulates in the buccal cavity, the lower jaw hangs 
down. 

Which points do you consider in making a prognosis 9 

Decided atrophy and a paralysis of long standing demand 
an unfavorable prognosis. When the paralyzed muscles do 
not respond to the faradic current and atrophy is marked the 
prognosis is unfavorable. 

Peripheral nerves exposed to serious traumatism are often 
incurable. I have had several cases of radial paralysis which 
required from nine to eleven months for recovery. 

Slight traumatism entitles to a favorable prognosis. 

A paralyzed muscle responding to the faradic current 
after the fourteenth day of its paralysis, as well as one exhib- 



260 PRINCIPLES OF VETERINARY SURGERY 

iting a hyperasthesia on application of the faradic current, 
entitle to a favorable prognosis. 

Generally speaking, paralyses of the facial and radial 
nerves are more favorable for a recovery than those of the 
crural or suprascapular nerves. 

Treatment of Nerve Paralysis. 

What do you mainly strive at in the treatment of paralysis ? 

1. To relieve the injured nerve from the direct cause of 
its paralysis. This is rarely possible, most nerves being 
l)eyond reach. 

2. To keep up the nutrition of the paralyzed muscle. 

As long as the muscle reacts to the faradic or galvanic 
current it is well to apply it. But most animals, and espe- 
cially horses, soon become very unruly on the application of 
electricity, and other agents have to be employed to prevent 
atrophy as far as such is possible. The next best agent is per- 
sistently ai^plied massage, blisters, setons, hypodermic injec- 
tions of strychnine and veratrine, saturated aqueous solution 
of sodium chloride, or bichloride of mercury ; veratrine must 
be used with care, as overdoses do not revive, but, on the 
contrary, fatigue and paralyze muscles. 

Inflammation of a Nerve (Neuritis). 

W hat are the causes of neuritis ? 

Traumatisms, infection, toxic agents. 
Is neuritis often seen in animals ? 

It does not occur often, except certain forms of neuritis 
of the eye. A great many authors claim that hemiplegia 
laryngitis (roaring) is the result of neuritis of the recurrent 
nerve, due to at first a pleurisy, the inflammation extending 



DISEASES OF NERVES 26L 

to the recurrent nerve, where it turns from left to right 
behind the arch of the aorta. That this is by no means the 
only cause of this important condition — roaring — the classical 
investigations of Prof. Thomassen, Utrecht, now conducted 
by him, tend to show. 

What are the symptoms of neuritis ? 

Injury of the nerve fibrils may lead to sensory or motor 
disturbances. Depending on the severity of the lesion, the 
symptoms are either those of irritation or destruction — that 
is, neuralgia or anesthesia, spasm or paralysis. 

Outline the treatment of neuritis 9 

Anodynes, counter-irritants, and, as a final, neurectomy. 

To what extent does the combined injection of cocaine and 
morphine influence neuritis ? 

During the past five years I have had several cases of 
chronic lameness in which I was unable to find pathological 
lesions sufiiciently severe to satisfy me as to the cause of the 
intermittent supporting-leg lameness which the horses exhib- 
ited. Two were lame behind and had been treated for several 
months with liniments and blisters by other gentlemen. The 
first one had injected a cocaine-morphine mixture over the 
posterior tibial nerve. The owner not having any use for him, 
rested him for two days, reporting the animal perfectly free 
from lameness a few days later. The second one was injected 
twice a week for two weeks and has remained free from lame- 
ness since. The other cases were lame in front, showing a 
moderate low lameness. In order to settle this question, I 
injected them over the high plantar neurectomy site. In all 
of them lameness was much less after the first injection on 
the following day than previously. These injections were; 
repeated three to four times before the lameness finally disap- 



262 PRINCIPLES OF VETERINARY SURGERY 

peared. Of course I liave injected, lots of horses without get- 
ting any results but temporary ones, and these were simply 
neurectomized subsequently. 

Therefore, it seems proper to employ a cocaine-morphine 
injection with a view to produce a cure in these and similar 
cases instead of neurectomizing the patient at once. 

What changes taJce place in a neurectomized nerve 9 

The whole of the peripheral part of the nerve — that is, that 
portion severed from the nerve trunk — undergoes granular 
and fatty degeneration ; one may term it a descending degen- 
eration; while from the central stump gradually a collateral 
anastomosis is established, eventually endowing the peripheral 
parts with limited nerve supply. But in those cases where the 
neurectomy wound has undergone purulent changes, and as 
the result of pus formation granulations became established 
and the nerve amputated below the upper wound commis- 
sure, thus allowing pinching and tugging upon the central 
nerve stump, interstitial inflammation of a chronic nature is 
the result and consequently a false neuroma. 



DISEASES OF ARTERIES. 

Arteritis. 

What is arteritis ? 

Inflammation of an artery. 
Name the varieties of arteritis. 

1. Endarteritis (inflammation of the inner coat). 

2. Mesarteritis (inflammation of the middle coat). 

3. Periarteritis (inflammation of the external coat). 
What forms of arteritis are recognized f 

According to the course of the inflammation, it may be 



DISEASES OF ARTERIES 263 

acute or chronic, aseptic or septic (purulent). According to 
its origin, it may be traumatic or hematogenous. 

Is arteritis a common surgical disease ? 

It is comparatively rare, especially the chronic form, also 
known as chronic deforming or atheromatous arteritis. 

Which variety of arteritis is of most practical interest 9 
Acute septic or purulent arteritis. 

How is an acute septic arteritis produced 9 

The arterial walls are infected with pus-producing bac- 
teria as follows : 

1. In septic diseases an infected embolus may become 
lodged in an artery and excite a purulent inflammation of the 
internal coats, which are swollen and infiltrated with pus 
cells. 

2. A purulent inflammation of the surrounding parts may 
spread to the adventitia and a purulent periarteritis results. 

3. The intima, some way or other, becomes injured and a 
purulent thrombus forms at that point, a condition termed 
purulent endarteritis. 

W hat is chronic deforming arteritis ? 

It is a chronic endarteritis followed by fibrous changes, 
fatty degeneration, cheesy collections and calcareous deposits 
in the arterial walls, as a result of which the walls of the 
artery become hard and inelastic ; may even rupture the 
lumen of the vessel ; may become narrower or even oblit- 
erated. 

In which animals is chronic arteritis exemplified ? 

In the horse it is the result of the presence of the 
strongylus armatus in the mesenteric arteries. 



264: PKINOIPLES OF VETERINABY SURGERY 

Aneurism. 

What is an aneurism 9 

It is a pulsating tumor containing blood, wMcli com- 
municates with the interior of an artery. 

Classify aneurisms. 

Idiopathic, traumatic. 

Hoiv do you divide iodiopathic aneurisms ? 
Cirsoid, tubular, sacculated, dissecting. 

W hat is cirsoid aneurism ? 

This is really no aneurism at all, but a neoformation, a. 
blood tumor. The vessel is tortuous. The shape of the blood 
tumor is irregular, compressible, pulsating and bluish, involv- 
ing, as a rule, a number of arteries held together by connec- 
tive tissue. 

What is a tubular aneurism 9 

It is an elongated dilatation of an artery involving all 
three coats of the artery. 

W hat is a sacculated aneurism ? 

Consists of a pouch-like dilatation, springing from tha 
side of an artery. 

Hoiv do you subdivide a sacculated aneurism ? 
Into a true and false aneurism. 

What do you understand by a true and false aneurism ? 

In the true sacculated aneurism, all three coats of the 
artery are distended and form the sac. In the false aneurism 
the wall of the pouch is practically made up of the adventitia 
only, which has undergone connective tissue proliferation. 



DISEASES OF AETEBIES 265 

What is a dissecting aneurism 9 

Here tlie internal arterial coat gives way usually at a 
point which has undergone atheromatous changes. The blood 
enters at this point, burrows along through the middle coat, 
finds in its course another atheromatous patch, and thus 
either reenters the current or extravasates into the surround- 
ing adventitia. 

W hat is an aneurismal varix 9 

A direct communication with an artery and vein. 

W hat are the causes of aneurisms 9 

The most common cause in the horse is a pin worm, the 
strongylus armatus, giving rise to a verminous aneurism in 
the mesenteric arteries, especially the anterior mesenteric 
artery, where the parasite produces a chronic deforming 
endarteritis and as a result of this an aneurism, also emboli 
and degenerative changes in the arterial coats, as a result of 
which the resisting power becomes limited, thus predisposing 
to an aneurism when the blood pressure becomes excessive, 
as by violent efforts, sudden strains, etc.; finally, traumatisms, 
as punctures. 

Are aneurisms often seen in animals 9 

Aneurisms of surgical interest are quite rare, and of all 
animals the horse exhibits them most frequently. 

In which arteries of the horse are aneurisms of surgical 
interest 9 
Submaxillary, carotid, nasal, brachial, aorta, iliac and 
femoral arteries. 

W hich symptoms do aortic aneurisms give rise to 9 

In the horse, aneurisms attaining the size of a man's 
head are occasionally seen at the origin of the common aorta 



266 PRINCIPLES OF VETERINARY SURGERY 

— that is, opposite the sigmoid valves ; in other words, at the 
sinus of the aorta, because this point is exposed to decided 
blood pressure. Such an aneurism may form adhesions with 
the neighboring organs, as stomach, liver, etc., or may even 
produce atrophy of the vertebral columns by its pressure 
against it. As a rule, they do not produce any symptoms 
at all during the life of the animal, but may lead to a rapid 
death by rupturing and internal hemorrhage. In other 
instances, they have given rise to vertigo, dyspnoea, stagger- 
ing. Those horses which bleed to death as a result of a rup- 
tured aneurism, stop suddenly, gasp for breath, fall down 
and die quickly, the immediate cause of the rupture being an 
extra muscular effort. 

Describe aneurisms and tJironibosis of the posterior aorta. 

The seat of predilection seems to be the quadrification of 
the aorta. Here an aneurism is either the result of an end- 
arteritis, or an embolus obstructs the vessel, coming from a 
thrombus located in some other vessel. Such an embolus may 
be swept on further and obstruct the iliac or femoral arteries. 

What anatomical changes are seen in the aorta under these 
circumstances f 

The walls of the aorta are thickened ; the intima espe- 
cially has undergone fatty and calcareous changes, also exhib- 
iting ulcerations. The interior of the artery is more or less 
obstructed by a thrombus of light color, which may extend 
anteriorly or posteriorly into the iliac arteries or even femoral 
artery. 

What symptoms does dilatation and thrombosis of the posterior 
aorta produce ? 

Rare in the ox, less so in the horse. When standing still 
or while walking slowly, nothing unusual is noticed. As soon 



DISEASES OF ARTERIES 267 

as the animal is exposed to active exercise, one or both hindlegs 
begin to sway, get weaker and weaker, the leg or legs seem to 
lose all power, the animal knuckles over and finally falls down, 
the heart beats violently, respiration is hurried and difficult. 
The whole body is covered with sweat, the mucous membranes 
are very red. After a little while all these symptoms lose 
themselves and the animal gets up none the worse, to repeat 
the performance when once more exposed to active exercise. 
Rectal palpation reveals the thrombosed artery as a hard, 
inelastic, dilated, longish object, with either no or decreased 
pulsation below the thrombus. Palpation of the paralyzed 
leg, as a rule, shows a wanting pulsation of the peripheral 
arterial branches and an icy coldness. 

W hat symptoms do dilatation and thrombosis of the internal 
iliac arteries produce 9 
The most marked ones are paralysis of the bladder, rec- 
tum, coccygeal muscles. 

What symptoms do dilatation and thrombosis of the brachial 
artery produce f 

The muscles of the affected foreleg tremble, the animal 
stumbles, finally drags the leg, may even fall down. In these 
cases, violent beating of the heart, dyspnoea, generalized 
sweating, are, as a rule, absent. 

Give an example of aneurismal varix. 

In rare instances, where jugular phlebotomy is unskil- 
fully practiced, the carotid artery may be punctured and thus 
adhesions between it and the jugular vein — an aneurismal 
varix — arises. 

Outine the treatment of aneurisms. 

When possible, the artery ought to be ligated above and 



268 PRINCIPLES OP YETERINARY SURGERY 

"below the aneurism and the latter severed, provided that th» 
artery is within reach and that by doing so the arterial supply- 
is not entirely cut off from the parts normally supplied by it,, 
as otherwise the peripheral parts would undergo necrosis, 
"being brought into a state of permanent anemia by the liga- 
tures. Other means of value in human surgery, as elastia 
bandages, compression, injections of ergot, tincture of iron, 
etc., are of no special value in veterinary surgery. Those- 
cases of aneurism of the posterior aorta, iliac arteries or 
femoral and brachial arteries are beyond reach, although 
some authors suggest iodide of potassium and massage, the 
former being of doubtful value, while the latter is simply 
dangerous. 

Rupture of Arteries. 

What are the causes of rupture of the larger arteries 9 

The various causes may exert their influence in a twofold 
manner. The assaulting agent may be directly or indirectly 
responsible for the rupture of the artery. In the former, the 
cause, a traumatism, directly injures the artery ; in the latter,, 
a diseased state of the arterial wall of the vessels disposes it to 
ruptures, as the resisting powers of the arterial walls are les- 
sened. Such indirect causes are falls and consequent concus- 
sion, excessive muscular efforts, etc. 

Which pathological states of the arterial walls predispose 
them to rupture 9 
Chronic deforming endarteritis, aneurisms and the de- 
structive influence of neighboring neoformations. 

What do you understand by spontaneous rupture of arteries? 
An arterial rupture, the result of an indirect cause. 



DISEASES OF ARTERIES 269 

The ruptures of ivhich larger arteries and veins are of clinical 
interest ? 
The seat of predilection of tlie aorta is at the aortic sinus. 
As previously stated, blood pressure is excessive here, there 
is naturally some dilatation, the walls are somewhat thin. In 
-cases of rupture at this point, the blood empties into the peri- 
cardium. The more common causes are : throwing an animal 
for an operation, fast running and jumping, wagon poles 
entering the thorax. Rupture of the pulmonary artery, the 
result of throwing the creature, has also been observed ; rup- 
ture of the obturator artery sometimes follows pelvic frac- 
tures ; rupture of the anterior mesenteric artery, especially 
^when affected with an aneurism, has been known to follow 
the throwing of a horse. Of the veins, the vena cava and por- 
tal vein occasionally rupture. 

What are the symptoms of rupture of the larger arteries and 
veins f 
Mucous membranes very pale, extremities cold, breath 
•cold, pulse very weak and soon beyond detection; the animal 
sways and falls ; occasionally convulsions. 

Outline the treatment of rupture of an artery 9 

Whenever possible, the bleeding vessel should be ligated, 
"but in the majority of cases the animal will bleed to death, as 
the vessels are beyond reach. 



270 PRINCIPLES OF VETERINARY SURGERY 

DISEASES OF VEINS. 
Injlanimation of Veins (Phlebitis). 

2Tame the varieties of phlebitis. 

1. Endophlebitis (inflammation of the inner coat). 

2. Mesophlebitis (inflammation of the middle coat). 

3. Periphlebitis (inflammation of the external coat). 

TV hat forms of phlebitis are recognised 9 

The course of the inflammation may be acute or chronio, 
aseptic or septic ; according to its origin, it may be traumatic 
or hematogenous. 

Is phlebitis a common surgical disease 9 

In former times, when asepsis was little understood, it was 
very common, especially jugular phlebitis, the result of bleed- 
ing the animal with surgically unclean instruments, etc. ; at 
the same time, phlebitis is much more common than arteritis.. 

Which form of phlebitis is of most practical interest ? 

Purulent phlebitis, also termed purulent thrombophle- 
bitis. 

Hoiv is purulent thrombophlebitis produced f 

1. In septic processes near a vein, as in cases of progres- 
sive septic cellulitis, the purulent process may spread to the 
vein. 

2. A venous thrombus may become infected from within. 
— that is, through the circulation, as in pyemia — or pus-pro- 
ducing bacteria may enter from without. 

Give some examples of phlebitis. 

In colts and calves, as the result of neglected antisepsis of 



' DISEASES OP VEINS 271 

the navel of the newly-lDorn, the umbilical vein becomes 
infected and a most fatal thrombophlebitis sets in, a state 
commonly termed omphalophlebitis; phlebitis of the saphena 
vein as a result of cellulitis of the hindleg is also quite com- 
mon. This phlegmonous condition of the hindlegs of heavily 
fed horses is usually termed lymphangitis. (This is not quite 
correct, as the lymphangitis is not a primary but a secondary 
pathological state, brought about by the absorption of irritants 
or toxic products of inflammation.) 

Another example of thrombophlebitis of much clinical 
interest is the thrombophlebitis of the veins of the nasal 
mucous membrane. 

Here the septum nasi shows little nodules, or small, elon- 
gated prominences of rosary-like arrangement of light to red- 
dish gray color, surrounded by a darker zone. This condition 
has been mistaken for glanders, but each grayish nodule 
represents a white venous thrombus, and the fact that no ulcer- 
ations take place differentiates it from glanders. 

What are the symptoms of phlebitis 9 

The vein is swollen, painful and hard, possibly knotty ; 
the surrounding tissues are edematous. In older cases a fistu- 
lous opening with a purulent discharge is seen — that is, in 
those which are superficially located, as, for instance, the 
jugular vein. 

Hoiu do you explain the swollen and knotty state of the inflamed 
vein 9 

The firmness of the inflamed vein is due to the formation 
of a thrombus and infiltration of its walls, while the knotty 
state is seen in those veins which are equipped with valves 
which, obstructing the flow of blood to a certain extent, 
encourage the development of the inflammatory process at 



272 PKINCIPLES OF VETERINARY SURGERY 

that place — that is, at the valves — and, as a consequence of 
this, the knots appear. 

Outline the treatment of phlebitis. 

Rest, laxatives in the earlier stages, astringent applica- 
tions, later moist heat ; abscesses are to be opened and asepti- 
cised. In infectious thrombophlebitis intravenous injections 
of collargolum or tallianine may be of advantage. As a rule, 
all treatment is futile. 

Varicose Veins (Varix). 

What is a varicose vein f 

A permanent elongation of the lumen of a vein, the lat- 
ter appearing tortuous and knotty. 

What are the causes of varix 9 

A predisposing moment lies in a sluggish return circula- 
tion, as is seen in the extremities, for instance; the most com- 
mon cause is chronic endophlebitis, also traumatisms j they 
may be congenital. 

How common are varicose veins in animals ? 

While more frequently seen than aneurisms, they are, on 
the whole, rare. Those reports of varicose veins of the rectal 
membrane (hemorrhoids) in the dog are mostly based upon a 
wrong diagnosis, being usually a diseased state of glands 
peculiar to the anus. At the same time, true varicose veins 
have been observed, as : hemorrhoids, milk veins of cows, 
upon the scrotum of dogs ; I have seen a varix of the spur 
vein of a mare ; finally, varicose veins on the spermatic cord, 
are not uncommon. 

Upon what do you base the diagnosis of varix ? 

The presence of an elongated dilatation of a vein, knotty 



DISEASES OF LYMPH VESSELS 273 

or tortuous in its course, either circumscribed and then fusi- 
form, tubular or sacculated in shape, or of a diffused charac- 
ter, is peculiar to varicose veins. 

What becomes of varicose veins 9 

They have a tendency to rupture and hemorrhage, forma- 
tion of thrombus, which may even become calcified, forming 
.a veinstone or phlebolith, or ulcerate. 

Outline the treatment of varicose veins. 

Ligation and excision of the varix is the most surgical 
treatment and gave me good results in the one case of varix of 
the spur vein which I met and operated ; others recommend 
the injection of carbolic acid, ergot, etc., into the perivascular 
structures — that is, the tissues about the vein. 



DISEASES OF LYMPH VESSELS. 
Lymphangitis. 

What is lymphangitis 9 

An inflammation of a lymph vessel. 
What are the causes of lymphangitis 9 

Lymphangitis almost invariably is caused by the entrance 
of septic bacteria or their products of metabolism into the 
•opened lymph vessel. 

Where is lymphangitis commonly seen 9 

In the neighborhood of infected wounds, as the result of 
jseptic cellulitis, in fistulous withers, saddle galls, etc. 

Mow do you explain this f 

Every tissue and organ is pervaded with lymph vessels. 
Their walls are thin and transparent, and adhere closely to 



274 PRINCIPLES OF VETERINARY SURGERY 

the surrounding tissue. Their function is to absorb, conse- 
quently septic products easily gain the circulation through 
them. Wherever a wound occurs^ be it ever so minute, lymph 
vessels are also opened. The skin is endowed with superfi- 
cially located lymph plexuses. Therefore, the smallest scratch 
is sufficient to permit infection, especially so on account of 
the hairy dress of animals, which swarms with bacteria of 
more or less virulence. For this very same reason also good 
results are obtained by antiseptic fomentations to the surface 
of the skin, as the antiseptic agent is taken up by them — that 
is, the superficial lymph vessels — and carried to the deeper 
lymphatics. For this reason, also, care must be exercised in 
applying strong antiseptic lotions over a large area of the 
smaller animals, as toxic effects may be obtained by their 
absorption. 

'What do you understand by specific lymphangitis 9 

A lymphangitis, the result of the action of specific germs, 
as in farcy, by the bacillus malleus, as in the streptococcus 
distemper of colts, as in skin tuberculosis of cattle. 

What changes take place in an inflamed lymph vessel 9 

Whenever irritants, or, as is usually the case, infectious 
substances enter lymph vessels, coagulation of the contents 
and stasis take place. The endothelial lining of the intima 
inflames, and part of it is thus destroyed. The thrombus also 
decomposes and becomes mixed with the pus from the intima, 
and a cream-like mass fills the interior of the diseased vessel. 
The limited powers of resistance of the walls of the lymph 
vessels easily permit the exit or entrance of pyogenous mate- 
rial which invades the loose connective tissue about the vessel,. 
start a purulent inflammation here, and an abscess is the result.. 



DISEASES OP LYMPH VESSELS 275 

These abscesses along the lymph vessels show a rosary-like 
arrangement. 

What are the clinical symptoms of lymphangitis ? 

As the result of stasis and thrombosis in the lymph vessel, 
there is a painful firm swelling along the course of the lymph 
vessel in which the surrounding tissues participate more or 
less ; abscess may develop at more or less regular intervals 
along the course of the vessel. The regional lymph glands, in 
which more or less of the irritants become deposited, swell, 
while fever, the result of the entrance of the pyogenous 
material into the blood current, is also a feature. 

Of course, not all cases of lymphangitis terminate with 
abscess formation ; a good example of resolution is the diffuse 
cellulitis and its secondary lymphangitis so commonly seen in 
the hindlegs of heavily fed and irregularly worked horses. I 
took occasion once before to state that the name given this 
disease in our country — that is, "lymphangitis" — was im- 
proper. No doubt this disease, the result of the entrance of 
some irritant into the lymph circulation either aseptic or other- 
wise, usually terminates favorably — that is, by resolution ; in 
other words, the irritant causing it is not sufficiently virulent 
to give rise to abscess formation, but, on the contrary, the con- 
tents of the diseased lymph vessel are absorbed and the parts 
return to almost their former state of vitality. 
Outline the treatment of lymphangitis. 

When due to an infected wound, prompt and thorough 
disinfection of the same is imperative. To prevent lymphan- 
gitis following surgical operations, which, while unnecessary, 
is yet frequently seen, antisepsis is essential. Moist antiseptic 
applications, provided they are persistently employed, give 
good results. As soon as an abscess forms it must be opened 
and drained and disinfected. 



276 PRINCIPLES OF YETERINAEY SURGERY 

Lymphangiectasis. 

What is lymphangiectasis ? 

By it are understood varicosities and dilatations of vari- 
able extent of lympli vessels. 

To ivliat extent do they interest the veterinary surgeon ? 

More from the standpoint of comparative surgery, as they 
are rarely seen in animals and belong to the domain of 
tumors. 



DISEASES OF GLANDS. 

Lymphadenitis. 

What is lymphadenitis ? 

An inflammation of a lymph glani. 
What are the causes of lymphadenitis 9 

Any irritant, usually an infectious agent. 
W hy are lymphatic glands so prone to inflammation ? 

The fact that they are reservoirs, receiving whatever 
material the lymph vessels gather, explains it. 

How does septic material reach the lymph glands ? 

First from without, via the lymph vessels ; in these cases 
there is also a lymphangitis present, the infection being car- 
ried there by the lymph vessels ; this form is known as 
lymphogenous adenitis. The second manner in which the 
septic material may reach the gland is through the blood cur- 
rent ; this form is termed hematogenous adenitis. 



DISEASES OF GLANDS 277 

JVTiat is perilymphadenitis ? 

An acute purulent inflammation of a lymph gland involv- 
ing tlie connective tissue surrounding the gland. 

What is specific lympliadenitis ? 

Inflammation of a lymph gland due to specific germs, as 
glanders, tuberculosis, actinomycosis, equine distemper, etc. 

What forms of lymphadenitis are of practical interest ? 

Depending on the cause, they may be traumatic or infec- 
tious as to their origin ; lymphogenous or hematogenous, 
primary or secondary, as to the course, acute or chronic; as to 
the type of inflammation, purulent, parenchymatous, inter- 
stitial. 

W hich are the more common diseases productive of lympha- 
denitis ? 

Septic cellulitis, infected wounds, pharyngitis, nasal 
catarrh, empyema of the maxillary sinus. 

Which lymph glands are often inflamed in horses and cattle ? 

In the horse : The submaxillary lymph glands, the glands 
underneath the mastoid humeralis at the point of the shoulder 
(shoulder abscess). 

Cattle : The glands of the head and neck and those of the 
m.ammary gland. 

Describe parenchymatous lymphadenitis. 

In this form, the glandular tissue proper undergoes 
changes as a consequence of the inflammation, the blood ves- 
sels dilate and a serous exudate occurs ; here the process may 
stop. There is swelling and pain due to the infiltration of the 
glandular tissue ; as soon as this is absorbed the swelling 
recedes. But when the irritant is of sufficient virulence, the 
process goes on further, the glandular tissue becomes necrotic, . 



278 pr.iNCiPLES OF veterinaky surgery 

the process may possibly spread to the surrounding connec- 
tive tissue and an abscess follows. In these cases where 
neither absorption nor abscess formation take place, a chronic 
lymphadenitis is the result. 

Describe purulent lymphadenitis. 

The infectious agent is of sufficient intensity to entail 
suppuration; almost invariably the surrounding connective 
tissue is involved in the inflammatory and suppurative pro- 
cess; the pus cavity thus formed rests in the connective tissue 
which encloses the more or less destroyed gland. In this 
form of adenitis the gland at first swells decidedly and is very 
painful, fluctuation appearing in due time, the pus being dis- 
charged either into the external world, or is absorbed, giving 
rise to septicemia or pyemia, or becomes inspissated. The 
most common example of purulent lymphadenitis is the strep- 
tococcus distemper of the horse. 

Describe chronic interstitial lymphadenitis. 

In this form of adenitis the interstitial connective tissue 
of the gland is* primarily involved, as a result of which the 
gland becomes hard and nodular, often forming adhesions 
with the adjacent structures. Such a gland is not painful. 
As a rule, this chronic form is the result of an invasion of 
the gland with specific germs, as those of glanders, tubercu- 
losis, but also accompanies chronic catarrhs of the upper 
respiratory tract. 

Outline the treatment of lymphadenitis. 

The parenchymatous form is best treated with moist heat 
and later with absorbents; the purulent form needs moist heat 
or a stimulating blister until the abscess can be opened, which 
is then given an antiseptic treatment. The chronic form is 
practically incurable. 



DISEASES OF GLANDS 279 

luflammation of the Mammary Gland (Mammitis — 

Mastitis). 

What are the causes of inastitis ? 

They are, in the vast majority of cases, of an infectious 
nature, more rarely due to traumatisms and cold. 

Hoiv may infection reach the udder 9 

The infection may he of lymphogenous origin — that is, 
reach the mammary gland through the lymph vessels; it may 
be galactogenous, entering through the opening at the teat; 
or it may be of hematogenous origin, reaching the gland 
through the general circulation. 

Which is the most common way through ivhich the infection 
enters the udder f 
Mainly through the opening at the end of the teat. 

Which bacteria and fungi are of practical interest in mas- 
titis 9 
The bacillus of tuberculosis, a number of specific mam- 
mitis bacteria, botryomyces, actinomyces. 

W hich varieties of mammitis are of practical importance 9 

Parenchymatous, catarrhal, acute interstitial, chronic in- 
terstitial, purulent, gangrenous mammitis. 
What are the terminations of mastitis 9 

1. Resolution. Between the third and tenth day after the 
outset of the inflammation of the udder, the more active 
symptoms disappear, the swelling and pain become less and 
the nature of the lacteal fluid once more approaches the nor- 
mal in quantity and quality. 

Such prompt resolution is by no means frequent. In cows, 
at least, mammitis has a chronic tendency. In these cases the 



280 PRINCIPLES OF VETERINARY SURGERY 

acute inflammatory symptoms recede, but the milk remains 
changed in composition and quantity and the gland becomes 
more or less indurated. In these cases complete resolution 
may take place during the next period of dryness, although 
this seems impossible on account of the connective tissue 
proliferation which has occurred. 

2. Purulent inflammation. Purulent inflammation and' 
abscess formation may take place in the subcutaneous connec- 
tive tissue ; also in the interglandular, interlobular and inter- 
stitial connective tissue ; no matter which of these is affected, 
the glandular tissue proper — that is, the parenchyma — is 
always involved. Depending on the structures involved, 
mammitis may be catarrhal (when the mucous lining of the 
excretory ducts is mainly involved), or there may be a phleg- 
monous mammitis (when the septic process spreads in the con- 
nective tissue framework), etc. Abscesses may be located 
deeply, and in these cases they usually empty into a lactifer- 
ous duct and give the lacteal secretion — that is, the milk — a 
purulent appearance, at the same time producing a purulent 
catarrh of the gland and its excretory ducts. But such an. 
abscess may not break but become encapsulated, or the lacteal 
secretion mixed with pus remains in a lactiferous duct and 
inspissates ; in either instance, hard, rather circumscribed 
lumps, deeply located in the udder, are felt. Abscesses super- 
ficially seated — that is, in the subcutaneous tissue — evacuate 
into the external world. 

3. Atrophy of the glandular substance proper. This is a 
common termination of mammitis, usually accompanied with 
induration of the affected parts. In these cases, a chronic in- 
flammation exists, as a result of which the interstitial connec- 
tive tissue becomes hyperplastic and the glandular tissue- 
proper atrophies. This may occur in a limited area or may 



DISEASES OF GLANDS 281 

involve a "whole quarter. In those cases witli decided hyper- 
plasia of the connective tissue, the udder appears enlarged ; 
in other words, it is an example of pseudo-hypertrophy — 
atrophy of the glandular tissue proper and hyperplasia of the 
connective tissue. An udder having undergone pseudo- 
hypertrophy is vulgarly termed a fleshy udder. Depending 
on the amount of glandular tissue destroyed, the functional 
activity of the part involved is either decreased or ceases 
entirely. In mild infections, the induration — that is, the con- 
nective tissue proliferation — may be confined to the lactifer- 
ous ducts and reservoir ; in fact, a catarrhal mammitis pre- 
vails. In such cases, the lactiferous ducts and sinus have a 
firm, knotty, pencil-like feel, giving rise to a condition com- 
monly termed hard milkers. 

4. Gangrene. Seriouscirculatory disturbances, the result 
of an inflammation produced by very virulent infectious 
material or a diffused purulent state of the connective tissue 
surrounding the gland, may produce thrombosis of the mam- 
mary vessels and thus death of the gland. Sequestration of 
the necrotic piece, depending on the size, takes place in one to 
eight weeks. Abscesses form here and there, and through 
them the gangrenous material is discharged. 

What are the complications of mammitis ? 

Metastatic arthritis usually of the fetlock and stifle Joints-, 
pyemia and septicopyemia. 

How does parenchymatous mammitis originate ? 

It is either of galactogenous or hematogenous origin. 

How does it terminate ? 

(1) By resolution. When this fails to take place, by (2) 
pseudo-hypertrophy or (3) atrophy. When the infection is 



282 PRINCIPLES OF VETERINARY SURGERY 

sufficiently malignant (4) by abscess formation or even by (5) 
gangrene. 

What are the clinical features of parenchymatous mammitis f 

The inflamed quarter is painful, hot, firm and decidedly 
swollen. In the earlier stages, the milk is watery, somewhat 
yellow or even colored red with blood and lumpy ; it contains 
fibrin. 

W hich anatomical structures are involved in catarrhal mam- 
mitis ? 
The mucous membrane of the lactiferous ducts, sinus and 
teat. 

What are scquelcB of catarrhal mammitis ? 

As a result of fibrous tissue changes the teat and lactifer- 
ous ducts may become obliterated or their lumen becomes 
much smaller (stenosis) ; fibrous membranes may develop in 
the galactopherous sinus, obstructing it, under which circum- 
stances the diseased quarter wastes away. Finally, the catar- 
rhal inflammation may extend to the interstitial connective 
tissue, producing hyperplasia of the same, as a result of which 
the diseased quarter becomes indurated and enlarged (pseudo- 
hypertrophy). 

W hat are the clinical features of catarrhal mammitis ? 

In the earlier stages, the gland is not swollen and but 
slightly painful on deep palpation. The milk is watery and 
lumpy, resembling whey. Later, as sclerotic changes set in, 
the teat and sinus feel like a pencil twirled between the fin- 
gers, while pseudo-hypertrophy or atrophy are readily recog- 
nized, especially when the diseased quarter is compared with 
healthy ones. 



DISEASES OP GLANDS 283 

Which structures are involved in acute interstitial mammitis? 
This cellulitis, due to infectious agents, attacks the skin, 
subcutis and interglandular connective tissue. 

Sow does acute interstitial mammitis originate 9 

It is either the result of an infection from without — that is, 
"by a traumatism — or a symptom of parenchymatous mam- 
mitis. 

What are the clinical symptoms of acute interstitial mam- 
mitis ? 

The affected quarter is hot, painful, swollen; the parts are 
firm; fever is present. In the earlier stages, the quality of the 
milk is unchanged. 

What do you understand hy chronic interstitial mammitis 9 

A chronic inflammation of the gland, with connective 
tissue proliferation and subsequent atrophy of the glandular 
substance proper. It may either be a sequel to the preceding 
forms of mammitis, or may represent an idiopathic condition 
setting in during the period of dryness, as a consequence of 
which the quarter becomes hard, painless and possibly very 
much enlarged. 

What are the 'peculiarities of purulent mammitis 9 

Parenchymatous and catarrhal mammitis, the result of an 
infection sufficiently severe to entail suppuration, give rise to 
abscess formation in the glandular tissue. The milk is mixed 
with pus; fluctuating spots indicate the abscesses; there is 
high fever. 

Under ivhat circumstances is gangrenous mammitis ob- 
served 9 

Parenchymatous mammitis due to an infection with very 
virulent bacteria, may, in the cow, produce such circulatory 



284 PRINCIPLES OF VETERINARY SURGERY 

disturbances as to give rise to gangrene of a quarter. In pur- 
ulent mastitis tlie same may take place, but the necrotic pro- 
cess is more likely to be circumscribed instead of diffused. In. 
sheep a very fatal gangrenous mammitis is due to the micro- 
coccus mastidis gangrenosse. 

Which clinical features entitle to the diagnosis of tubercular^, 
actinomycotic and hotryomycotic mammitis f 

1. Tubercular mammitis : It is either of hematogenous or 
galactogenous origin ; is a chronic mastitis ; as a rule, the= 
hindquarter is diseased, but the pathological process may by 
and by involve other quarters. When the hindquarter ia 
tuberculous the supramammary lymph glands are enlarged 
and hard, the quarter itself shows at first a diffused firm swell- 
ing which gets harder and harder, which usually is painless. 
In this swelling develop presently nodules of variable size^ 
being often of stony hardness; the glandular tissue adjacent to- 
these nodules atrophies, causing these deeply located nodules- 
to become quite prominent. The quantity and quality of the; 
milk is apparently quite normal for some time (in which.. 
respect it differs materially from other chronic forms of mas- 
titis), and for a month looks like healthy milk; from this time 
on (exceptions, of course, exist), it becomes watery, until 
finally it becomes a turbid, yellow, watery fluid containing 
tubercle bacilli. This condition, after existing two to four 
months, terminates in death. 

2. Actinomycotic mammitis : Seen in the sow and cow.. 
Most likely of galactogenous origin. The actinomycotic pro- 
cess may be localized or may be diffused ; that is, it may be^ 
confined to one quarter or involve the whole udder. When, 
only one quarter is diseased, numerous bean to ego, sized nod- 
ules form in the quarter, which represent as many abscesses 



DISEASES OF GLANDS 285 

surrounded by dense connective tissue capsules. These break 
and actinomyces pus is discharged, being a slimy, purulent 
fluid. In those cases where the whole udder is actinomycotic, 
the udder, as a whole, becomes indurated, slowly enlarges, 
showing nodules which eventually break and discharge the 
pus. 

3. Botryomicotic mammitis : This chronic mammitis, in 
which connective tissue hyperplasia with abscesses and fistu- 
lous tracts is observed, is supposed to be due to the entrance 
-of the botryomyces equi either through a cutaneous wound or 
through the openings at the teat of the mare. At first the 
symptoms of a parenchymatous mastitis involving one-half of 
the udder are seen, presently little abscesses form, break and 
give rise to fistulous tracts, the mouth of which granulates 
freely ; these may heal and small, puckered-in nodular scars 
form wherever the fistulous opening was. While this goes on, 
the udder, as the result of the fibrous tissue proliferation, en- 
larges and becomes hard ; the soft tissues of the thigh become 
involved, in cases of long standing, and locomotion is 
disturbed. Unless this condition is treated properly in time, 
•a cachetic state and death are sure to follow, which, of course, 
may take years. 

"Outline the treatment of mammitis. 

Decrease the amount of feed and give a saline purgative. 
In the acute stages, empty the udder often and gently, but do 
not let the infected milk run upon the floor, but catch it in a 
T'Bssel so it may be properly destroyed. Before and after each 
milking the udder ought to be washed with an antiseptic 
solution. The injection of antiseptic solutions into the milk 
sinus does not always give good results ; the only safe ones 
are a 4 per cent, boric acid solution or one containing 1 to 2 



286 PRINCIPLES OF VETERINARY SURGERY 

per cent, of alum. Moist heat continuously applied is of 
advantage, especially in the interstitial inflammations of an 
acute type. In chronic cases, massage is indicated. Lini- 
ments and ointments containing camphor, belladonna, tur- 
pentine, especially iodine and lard (1:20), are largely em- 
ployed. Lately the inflation of the udder with sterilized 
air has been recommended. In the treatment of abscesses 
the knife is required, with subsequent antiseptic injections. 
In gangrenous, botryomycotic and actinomycotic mammitis, 
amputation of a quarter or whole udder may become neces- 
sary. 



DISEASES OF THE SKIN. 

Dermatitis (Inflammation of the Skin). 

What are the causes of dermatitis 9 

It may be of a specific nature, as glanders or tuberculosis; 
it may be infectious, as pus-producing bacteria ; it may be 
traumatic, as abrasions, pressure, blows ; it may be thermic, 
as the heat of the sun, fire heat, steam ; it may be chemical,, 
as caustics, etc. 

How do you classify dermatitis 9 

According to its course and extent : acute and chronic, 
circumscribed and diffused, superficial and deep. 

What forms of dermatitis are of practical interest to the sur~ 
geon 9 

Erythematous dermatitis, suppurative dermatitis, gan- 
grenous dermatitis, chronic hyperplastic dermatitis. 

W hat do you understand by erythema 9 

Erythematous dermatitis represents a hyperemic state of 
the skin, mainly involving the papillary layer. 



I DISEASES OF THE SKIN 287 

What changes may take place in the sJcin in erythema ? 

The bloodvessels dilate, tlie papillary layer swells more or 
less, there is serous infiltration of the tissues (inflammatory 
edema). In cases where the hyperemia of the skin persists 
for some time, desquamation of the epithelium follows. 
Should the serous inflammation accumulate in the rete 
mucosum, blisters are formed as the infiltrated serum raises 
the epidermis from its basis. 

In tvhat animals is erythema seen ? 

In all animals, but is best observed in those which have a 
non-pigmented skin. In the horse, seats of predilection are 
those parts exposed to harness friction and in the flexion sur- 
face of the fetlock. 

Which are the clinical symptoms of erytliema ? 

Very slight swelling, pain and arterial redness of the skin; 
later the hair may drop out and the epidermis scales off. 
When in the flexion surface of the pasterns, the pain may be 
suflficient to produce lameness (erythema of the flexion surface 
of the fetlock represents the mildest form of what is vulgarly 
termed "scratches"). 

Outline the treatment of erythema ? 

Remove the irritant; mild astringents are indicated. 
What is suppurative dermatitis ? 

A suppurative inflammation of the skin due to an infec- 
tion with pus-producing bacteria. 
How does suppurative dermatitis occur ? 

Either diffused and superficial, when it is termed puru- 
lent dermatitis, or circumscribed, when it is known as derma- 
titis pustulosa; or in those cases where the suppurative pro- 
cess is confined to the hair follicle and its immediate neigh- 



288 PRINCIPLES OF VETERINARY SURGERY 

borliood it is termed furuncle (boil) ; finally, a carbuncle may 
be said to be a collection of furuncles. 

What is the seat of predilection of furuncles in animals ? 

All those parts exposed to mechanical irritations, as in the 
dog, the neck and nose, and in the horse those regions exposed 
to harness pressure. 

Outline the treatment of furuncles. 

In the formative stage, warm, moist fomentations ; later, 
the abscess is to be opened and the necrotic center, the core, 
as it is commonly termed, must be removed ; next, disinfec- 
tion and subsequent antiseptic treatment. 

What is gangrenous dermatitis ? 

It is an inflammatory condition of the skin, leading to 
necrosis of the affected skin. 

What are the most common causes of gangrenous dermatitis ? 

Burns, scalds, caustics, cold, infectious agents. 
Where is gangrenous dermatitis often seen 9 

As a result of saddle pressure and in the flexion surface 
of the fetlocks, representing a certain form of eczema 
(scratches). 

W hat is chronic hyperplastic dermatitis f 

A chronic inflammation of the skin and subcutis charac- 
terized by connective tissue proliferation of the skin and sub- 
cutis. 

Under what other name is chronic hyperplastic dermatitis 
Tcnown 9 
Elephantiasis. 

What is the etiology of elephantiasis 9 

It is the result of chronic inflammatory processes, most 



DISEASES OF THE SKIN 289 

frequently seen in the liindlegs of horses after repeated attacks 
•of cellulitis, lymphangitis, ulcerations ; in these cases the 
acute inflammatory symptoms subside, but infected foci 
remain in the tissues and lead to chronic irritation, as a result 
of which an excessive amount of connective tissue is produced, 
and thus the enlargement of the affected parts. 

What is eczema, and to ivhat extent is it of surgical interest ? 
Eezema is an acute or chronic dermatitis running a typi- 
cal course, and of surgical interest especially in the horse, 
•where its seat of predilection is the flexion surface of joints, 
especially the fetlock. 

Under what commo7i name is eczematous dermatitis usually 
known ? 
Depending upon the part which is affected and stage of 
the disease, it is known as cracked heels, scratches, grease. 

Which varieties of dermatitis are observed in scratches, 
cracked heels a7id grease. 

1. Dermatitis erythematosa : This is the lightest form of 
"the so-called scratches. When occcrring in the non-pigmented 
skin of the finely bred horse — it being rarely observed in the 
-coarser breeds — the skin is seen to be red, warm, more or less 
swollen and somewhat painful. Unless the irritant is removed 
it may develop into the following variety of dermatitis : 

2. Dermatitis eczematosa : Probably the first thing which 
is noticed is that the horse limps a little the first few steps it 
takes, the hairy skin rendering it difficult or impossible to 
-observe the earlier forms of this dermatitis — namely, the pap- 
ular (groups of pinhead sized pimples) and vesicular (little 
Trusters) stages — although the latter is more readily noticed 
than the former. The next form, that of red eczema (stadium 
madidans), is the one when the surgeon is called in. Here is 



290 PRINCIPLES OP VETERINARY SURGERY 

found an infiltrated, swollen surface, from which more or less 
serum exudes, its watery parts evaporate and a crust remains 
behind. Now the stadium crustosum is reached. On removal 
of the crust, a raw, red, oozing surface is seen. Proper treat- 
ment at this time is followed by loosening of the crusts, the 
surface desquamates (stadium squamosum) and the destroyed 
epidermis is replaced. Should the animal not receive the con- 
sideration which it should, especially when kept at work, this 
regular course of healing does not take place and the skin be- 
comes fissured. In these cases chronic connective tissue 
changes are a sequel, giving rise to the formation of keloids. 

3. Dermatitis gangrenosa : This variety of dermatitis 
may arise independently as a spontaneous skin necrosis, or 
may follow in the wake of a neglected and infected eczema- 
tous dermatitis, especially when the skin is fissured and the 
animal worked in slushy and very cold weather. In gangren- 
ous dermatitis setting in spontaneously, intense and sudden 
lameness is observed. The animal, most likely, was put away 
the night before in good health and in the following morning 
walks upon three legs ; a part of the leg, or the greater por- 
tion of it, may be swollen, the diseased skin is soft and has 
a soapy feel, a reddish liquid oozing from it. In two to five 
days the necrotic, gray, soft piece of skin becomes loose, the 
defect being eventually covered with granulations, unless the 
septic process invaded adjacent structures, as the lateral carti- 
lage, tendon sheath, etc., when symptoms peculiar to these 
conditions predominate. 

4. Dermatitis chronica verrucosa : Usually affects the 
hindlegs of long-haired horses, starting at some place in the 
region of the fetlock, from where it may spread. 

The hair has dropped out, more or less, and the surface is 
covered with a gray, smeary mass, smelling badly. This 



DISEASES OP THE SKIN 291 

■mass consists of epidermal cells macerated by the exudate. 
In this skin disease there is an active proliferation going on 
in the papillary and malpighian layer, at the same time 
involving the cutis and subcutis. The papillae of the papil- 
lary layer enlarge greatly and appear as wart-like excres- 
cences. In the rete mucosum, which, of course, rests right 
upon these enlarged papillae, cells are formed so rapidly that 
they do not have time to become horny, but are continuously 
soaked and macerated by the inflammatory exudate, so that 
they appear upon the surface as a gray, smeary mass previ- 
ously mentioned ; should the cell production in the rete 
mucosum be less rapid, the surface has a gray, dusty appear- 
ance. The dropping out of the hair is explained by the fact 
that the pathological process extends to the hair follicles. As 
a result of the connective tissue proliferation of the cutis 
and subcutis in cases of long standing, elephantiasis of the 
leg is a consequence. 

What is the prognosis of dermatitis eczematosa 9 

When the horse can be given complete rest recovery takes 
place in eight to fourteen days. In those cases where the 
skin is fissured, unfavorable complications may arise ; at any 
rate, the treatment is much more difficult and considerable 
time and skill are required to prevent the formation of large 
keloids. 

What is the treatment of eczematous dermatitis ? 

In the earlier stages, a warm, moist, antiseptic cataplasm 
is indicated to remove all the crusts. Of the endless number 
of agents employed in this disease, tannoform or red oxide of 
mercury ointment (1 : 5) has given me the best results. In the 
earlier stages, where excessive granulations are to be com- 
bated, these may have to be snipped off and a powder of one 



^92 PEINCIPLES OF VETERINABY SURGERY 

part of alum and two of tannoform, held in place by a pres- 
sure bandage, is indicated. The average time required to 
heal this state is about fourteen days. 

W hat is the prognosis of dermatitis gangrenosa 9 

This depends entirely on the extent of the lesion and the 
intensity of the infection. No definite rule can be given. 

What is the treatment of gangrenous dermatitis ? 

In the beginning, warm antiseptic cataplasm to hasten 
separation of the necrotic piece. Later the wound is dried off 
and healed under a scab with tannoform or alum tannoform 
powder ; the latter is used, provided the granulations are ex- 
cessive. Complications, as quittor, septic tendovaginitis, 
«tc., have to be treated accordingly. Frohner reports good 
results by treating these cases with tincture of iodine. 

What is the prognosis of dermatitis chronica verrucosa ? 

Weeks and months are often required to produce a cure. 
The greater the proliferations of the papillary layer of the 
skin — that is, the larger the wart-like excrescences — the more 
difficult the treatment. In those cases where the skin is 
wrinkled, and the warts large, a cure is excluded. 

What is the treatment of chronic verrucous dermatitis ? 

Should the parts be covered with crust and the whole 
region edematous, apply a warm antiseptic cataplasm for 
twenty-four hours, wash the parts perfectly clean and dry 
them ; now apply with a brush three times daily sulphuric 
acid one part, alcohol twenty parts. For cases which ooze very 
persistently, a dressing moistened with the above liquid may 
be applied. After the parts dry off, use daily red oxide of 
mercury one part, lard five parts. There are ever so many 
other remedies, but none as reliable as the above line of treat- 
ment suggested. 



DISEASES OP THE SKIN 295^ 

Burns and Scalds. 

What is a hum ? 

The destruction of the skin and underlying tissues due to 
an exposure to excessive temperatures. 

What are the causes of hums and scalds f 
Fire, caustics, steam, hot water, etc. 

Under what circumstances are hums of therapeutic value ? 

When employed as the actual cautery, also when chemi- 
cals are used as rubefacients, vesicants and escharotics. 
What points does the surgeon take into consideration in 
hums ? 

The intensity and the extent of the burn. 

Depending on the intensity of a hum, luhich three degrees are 
of practical value f 

First degree : An excessive temperature acts but momen- 
tarily, followed by dilatation of the bloodvessels, especially 
the arteries ; consequently the skin not provided with pig- 
ment appears bright red (erythema) ; at the same time there 
is more or less pain and some swelling due to serous infiltra- 
tion of the skin. These symptoms disappear in a few hours, 
but are followed by desquamation of the epidermis. 

Second degree : An excessive temperature acts a little 
longer than in the first degree. As the result of this a serous 
exudate accumulates under the horny layer of the skin, rais- 
ing it ; in other words, producing larger and smaller blisters. 
These blisters are not very well seen in animals with a hairy 
coat, as the hair, being firmly fixed in the cutis, holds the 
epidermis down. The swelling and pain are considerable. 
The pain disappears in about twelve to twenty-four hours. 



294 PEINCIPLES OF VETERINARY SURGERY 

while the swelling may persist for several days. The con- 
tents of the blisters are absorbed and the blister, unless opened, 
dries up in a few days. A new horny layer is formed and the 
old one thrown oif. In those cases where the blister is 
opened, nine to fourteen days pass before a new epidermis is 
reproduced. 

3. Third degree : An excessive temperature acted for 
some time. Here carbonization of the tissues occurs. Under 
pus formation the necrotic tissues are loosened and thrown 
off, after which granulations spring up and finally a scar 
leading to more or less deformity forms. 

What points are to he considered in the prognosis of a hum ? 
Primarily the extent and next the intensity of the burn. 

How much of the hody surface must he hurned to entitle to a 
douhtfid or unfavorable prognosis 9 
It seems that in the horse when one-fifth to one-tenth of 
the body surface is destroyed, a fatal termination is imminent. 

What constitutional symptoms do extensive hums produce ? 

Dogs are very much excited ; later distinct collapse with 
dyspnoea and subnormal temperature follows ; in other 
instances, there are convulsions. In horses, after extensive 
burns, especially when the mucous membrane of the respira- 
tory tract is injured by the inhalation of hot and acrid vapors, 
a fatal hemoglobinuria finishes the creature. 

How is the appearance of hemoglohinuria after extensive 
hums explained ? 
As a result of the action of the heat upon the skin capil- 
laries, the blood disintegrates and hemoglobinuria is created 
at once. The hemoglobin which now circulates in the blood 
current causes hemoglobinuria. 



DISEASES OF TEE SKIN 295 

How is sudden death after hums explained 9 

The most generally accepted theory is that the death from 
"burns is the result of poisoning, the poison being a chemical. 
It has also been pointed out tliat the white blood cells, by the 
action of the heat, disintegrate, and that as a result of this 
certain toxic agents are formed which cause necrosis of the 
internal organs by coagulating the blood in the capillaries of 
such organs. Furthermore, certain chemicals, as ammonia, 
prussic acid, etc., are supposed to form. 

In luliich respect do scalds differ from hums 9 

There is very little difference. From the standpoint of 
intensity, the same three degrees as given under burns are con- 
sidered. Right here it may be stated that cutaneous injuries 
following the actions of strong alkalies and acids are more 
closely related to a burn than a scald. 

Outline the treatment of hums and scalds. 

Burns of the first degree are rarely treated by the veter- 
inarian. In those of the second degree the blisters are opened 
at the most dependent part under antiseptic precautions; parts 
which can be bandaged are then dressed with aristol, boric 
acid, zinc oxide 1 : 2, or when bandages cannot be applied fre- 
quently painted with Carron oil (lime water and linseed oil 
aa). Burns of the third degree require unirritative germi- 
cidal lotions. Sloughs are removed and trimmed away 
wherever possible. As soon as the parts begin to granulate, 
astringent and antiseptic powders, as tannoform, are indi- 
cated . In those cases where such extremities as the tail and 
ears are burned beyond the possibility of recovery, they are 
to be amputated. Burns the result of alkalies are neutralized 
by dilute acids — for instance, vinegar ; while those due to 
acids are treated with alkalies— as soap water, for instance — 



296 PRINCIPLES OF VETERINARY SURGERY 

after which they are treated as other burns. Internally, stim- 
ulants are of value. 

How do you treat hums due to lightning and strong electric 
currents ? 

The treatment of wounds due to lightning and strong cur- 
rents, as they are occasionally seen in the larger cities when 
the overhead wires of an electric car system break, are 
treated in the same way as other burns. The paralyses fol- 
lowing these electric strokes usually terminate favorably. 

Frost Bite (Congelatio). 

Is the detrimental action of excessive cold in animals com-- 
mon 9 
It is not. Freezing to death, on the whole, is rare; partial 
freezing is quite frequent, especially those parts devoid of a 
well-developed, hairy dress, as the scrotum in bulls and th& 
coronary region and hollow of the heel in horses' ears and tails 
of pigs. 

Hoiv does the hairy coat of animals protect against frost bites ? 
Dry hair folded against the body surface is a poor con- 
ductor of heat ; at the same time, between the hair and the 
skin air spaces are formed which prevent the radiation of the 
body heat. All this is changed as soon as the hair becomes 
wet from slush or snow. At this moment the air spaces 
formed by the dry air are done away with and the radiation 
of the body heat is no longer prevented, but rather encour- 
aged. Consequently the vitality of such a part is lowered 
and the whole body temperature lowered. Nevertheless, the 
lay of the hair and the greasy state of the skin — made so by 
the product of the sebaceous glands— strongly protect the 



DISEASES OF THE SKIN 297 

skin against an ordinary wetting, and the prolonged action of 
moisture is necessary to soak the cutaneous covering. It is 
for this reason that the lower extremities, continuously 
exposed to moisture, as the coronary region and heels of the 
horse's hoof, more easily succumb to the action of excessive 
cold. Another reason, and a potent one, why the lower 
extremities exhibit frost bites, more commonly lies in the fact 
that wounds of more or less consequence are often met with 
in those localities. The cold lowers the vitality of the parts, 
purulent bacteria always abound, they enter the wounds, 
multiply and are followed by more or less extensive necrosis 
of the parts invaded by them. I really think that the vast 
majority of so-called frost bites of the lower extremities in the 
horse are no frost bites at all, but septic infections made pos- 
sible by the lowered vitality of the tissues due to the exposure 
to prolonged and excessive cold, which, when active as mois- 
ture, macerates the epidermis, thus predisposing to infections. 

Hoiu does excessive cold affect the skin 9 

Three degrees of freezing are recognized. 

What are the peculiarities of these three degrees ? 

First degree : Due to moderate cold acting temporarily. 
The changes occurring in pigmented skin are either not to be 
seen or are ill defined. The changes which take place are : 
As the result of the action of the cold anemia of the skin sets 
in as the arteries contract. Next the arteries dilate and the 
venous circulation becomes gorged, for which reason the skin 
appears dark red ; at the same time more or less swelling and! 
pain are present. 

Second degree : Due to a more persistent action of cold.. 
Here the same changes as above occur, only the exudation 
under the epidermal layer is excessive, and consequently" 



298 PRINCIPLES OF VETERINARY SURGERY 

large and small blisters form ; contrary to burns, there is 
more tendency to necrosis of tlie frozen parts. 

Third degree : Due to the persistent action of excessive 
cold. The fluids in the skin either congeal or the circulatory 
disturbances, viz.; venous stasis, lead to necrosis of the 
exposed part, and since the skin is usually overfilled with blood 
that form of necrosis known as moist gangrene is mostly 
observed. Suppurative separation of the gangrenous tissue 
takes place, followed by granulations and finally cicatrization. 

How do you treat congelations ? 

The veterinarian is not often called to treat those of the 
first degree, should it be the case through friction with snow 
and ice, until the temperature of the part is about normal, 
when friction with spirits of camphor and next a dry cotton 
dressing are indicated. The main point in such cases is to 
gradually bring about a return of the heat-producing power 
of the affected part. Freezing of the second and third degree 
is treated in the same manner as burns of that class. 

W hat prophylactic means can he employed to prevent freezing ^ 
of the lower extremities of the horse f 
The loss in time and money to horse owners from gan- 
grenous dermatitis either due to partial freezing or infection, 
or most likely to a combination of these two factors soon after 
slushy weather sets in, is material. I have for a number of 
years received excellent results by ordering the hollow of the 
heel and the coronary region painted with carbolized neats 
foot oil (carbolic acid 1, neats foot oil 33 parts). This is 
applied every morning as long as the ground is slushy. In 
the evening it is washed off and the parts dried by rubbing 
them with wood shavings, which are used here generally for 
bedding. While incurring some extra work on the part of 



DISEASES OF THE SKIN 299 

the teamster, the good results following this practice warrant 
it, which of course is the decisive feature. 

Inflammation of the Podophyllous Membrane 
(Pododermatitis) . 

What anatomo-physiological facts are of interest in the surgi- 
cal diseases of the pododerm ? 

This subject has been exhaustively dealt with in my work 
on " The Clinical Diagnosis of Lameness of the Horse." The 
reader therefore is referred to it for details. 

Generally speaking, the pododerm is related in its make-up 
to the skin ; in fact, it is a continuation of the external cuta- 
neous covering, the former not producing any hair or epider- 
mis, but horn instead. The rete malpighi, which covers the 
cutis proper, is strongly developed. The papillary body of 
the cutis is exceedingly prominent, large papillae stud the sole 
and frog and especially the coronary cushion. In the region 
corresponding to the wall of the hoof the papillary layer is 
enormously developed, represented by the primary and sec- 
ondary laminae, which again are protected by a strong rete 
malpighi. Composed of many vessels resting in loose connec- 
tive tissue, the vascular layer is next to the papillary body ; 
the deepest layer ensheaths the os pedis, representing the 
periosteum. The subcutis, the basis for all these layers, is 
irregularly distributed. It is only found underneath the cor- 
onary cushion, sensitive laminae of sole and wall (excepting 
over the os pedis), fibro-cartilages, tendon of the extensor 
pedis, and finally, although materially modified in shape, of 
the plantar cushion. 

What varieties of pododermatitis interest the surgeon ? 

The inflammatory processes may be acute and chronic. 



300 PRINCIPLES OF VETERINARY SURGERY 

circumscribed and diffused, superficial and deep; or parenchy- 
matous, tliey may be aseptic or septic, serous, ]iemorrliagic> 
purulent, phlegmonous and gangrenous. 

What every -day term is applied to heTnorrhagic pododerma- 
titis ? 
Corns. 

What is diffused, superficial, aseptic pododermatitis termed f 
Founder, laminitis. 

Give an examjjle of chronic productive pododermatitis. 
Kerapliyllocele, also termed keratoma. 

What regions of the pododerm only can undergo phlegmonous^ 
inflammation ? 

Only those which are endowed with a layer of connective 
tissue. Septic cellulitis therefore develops: underneath the 
coronary cushion, termed subcoronary cellulitis; adjacent te 
the lateral cartilage, termed parachondreal cellulitis (which 
process initiates all quitters) ; and finally, in the connective 
tissue of the plantar cushion (fibro-fatty frog). 



DISEASES OF MUCOUS MEMBRANES. 

The diseases of which mucous membranes are of surgical 
interest 9 
Inflammation of the mucosa of the eye (conjunctivitis) ; 
that of the nasal canal (rhinitis) ; that of the buccal cavity 
(stomatitis) ; that of the pharynx (pharyngitis) ; that of the 
rectum (proctitis) ; that of the vagina (vaginitis) ; that of the 
uterus (endometritis) ; that of the bladder (cystitis). 



DISEASES OF THE SUBCUTIS 301 

What are the causes of inflammatioii of the mucous mem- 
hranes ? 
In regard to the etiology and varieties of the inflamma- 
tory processes of the mucous membranes the same points hold 
good which have been considered under "Inflammation of 
the Skin." 

How do you treat the surgical diseases of the mucous mem- 
branes ? 
The treatment may be an operative one or the application 
of antiseptics and astringents is indicated. 



DISEASES OF THE SUBCUTIS. 

Edema. 

What is edema ? 

A dropsy or serous infiltration of the subcutaneous con- 
nective'tissue. 

What varieties of edema are of surgical interest 9 
Inflammatory edema, passive or stasis edema. 
What is an inflammatory edema 9 

A serous inflammation of the cutis and subcutis due to 
infectious, toxic, thermic or traumatic agents. In other 
words, an infectious, thermic, traumatic or toxic agent pro- 
duces an inflammation of the cutis and subcutis; as a result of 
this inflammation a serous exudate forms ; this exudate infil- 
trates the lymph spaces of the cutis and subcutis and the con- 
dition known as inflammatory edema is present. 

W hat is collateral edema 9 

An inflammatory edema of any cutis and subcutis imme- 



302 PRINCIPLES OF VETERINARY SURGERY 

diately surrounding a suppurative focus (for instance, an 
abscess). 

What are the symptoms of inflammatory edema 9 

The diseased section is swollen, its overlying cutaneous 
covering is tense, hot and painful. 

What is a stasis edema ? 

A dropsical state of the lymph spaces of the cutis and sub- 
cutis due to an obstruction of the venous or lymphatic circu- 
lation. 

How is stasis edema explained ? 

The return flow of the blood may be variously interfered 
with. Lowered vitality due to debilitating diseases, old age, 
weak heart, want of exercise, chronic heart, lung, kidney, 
liver and blood diseases all have a tendency to produce cer- 
tain changes in the endothelial lining of the walls of the 
blood vessels, as a result of which liquid and corpuscular ele- 
ments can leak from the vessel holding them. Pathologists 
generally agree that injury to the endothelial cells and cement 
substance between these cells are the most important factors 
in allowing a transudation to take place — supported, of course, 
by intravascular pressure and anything interfering with 
the free flow of the blood. An obstruction to the lymphatic 
circulation in itself rarely produces a stasis edema, because 
lymph vessels anastomose too freely, but they assist in the 
production of passive edema whenever the demands made 
upon them are greater than their capacity for work ; in other 
words, the lymph spaces, instead of being continuously and 
regularly emptied, remain filled with the transudate. 

What are common examples of stasis edema in animals 9 
In the horse, stocking of the hindlegs, even of the sheath. 



DISEASES OF THE SDBCUTIS 303 

is common. In the pregnant mare and cow, stasis edema of 
the udder, hindlegs and along the belly is often observed. 

What are the symptoms of stasis edema ? 

In non-pigmented skins, a soft to doughy swelling, which 
may or may not pit on pressure, of bluish color, painless. and 
cool, characterizes this variety of edema. 

How do you treat edema ? 

The treatment of inflammatory edema is an antiphlogistic 
one, therefore hydropathic means, antisepsis, and incisions to 
rid the tissues of septic material are necessary. 

The treatment of stasis edema depends, necessarily, on 
the cause of this condition; externally, hand rubbing, bandag- 
ing, slight vesication, scarifications ; internally, tonics, 
diuretics, purgatives, etc., are indicated. 

Emphysema. 

What is subcutaneous emphysema 9 

An accumulation of air in the meshes of the subcutaneous 
tissue. 

Hoiu does subcutaneous emphysema arise ? 

1. By traumatism. 2. By septic processes. 

Explain traumatic emphysema. 

Air may enter through any cutaneous wound and infil- 
trate the subcutaneous tissue ; wounds about the neck, elbow 
and thorax especially predispose to emphysema, as the move- 
ments of these parts produce a sucking and pumping action — 
that is, the air is, so to speak, sucked through the skin wound 
into the subcutaneous tissues, and from here it is pumped up 
further into the tissue by the compressing action of the cuta- 
neous cover. But air may also be forced into the subcutane- 



304 PKINCIPLES OP VETEEINARY SURGEEY 

ous tissue from within — that is, following injuries to the par- 
enchyma of the lung, perforation of the esophagus, rupture of 
the rectum. When air or gases accumulate in the cavities of 
the body, as the thorax (by perforating chest wounds), it is 
termed pneumothorax; or, when accumulating in the rumen 
of a cow, stomach or intestines of other animals, it is termed 
tympanitis and of surgical interest, as the trocar and canula 
may be called into play to relieve the bloated state. 

What are the symptoms of emphysema ? 

A more or less diffused swelling, painless, of normal tem- 
perature, producing a fine, crackling sensation when stroked 
with the hand, and tympanitic on percussion. 

W hat is the prognosis of subcutaneous emphysema ? 

Favorable, unless it is a symptom of serious destruction 
of vital tissues. 

What becomes of the air in the subcutaneous tissue ? 

It is gradually absorbed by the lymph and blood vessels. 
W hat is septic emphysema ? 

The accumulation of putrefactive gases, the product of 
gas-producing bacteria, in the subcutis. 

W hat is the etiology of septic emjohysema 9 

Bacteria capable of manufacturing putrefactive gases in- 
vade the subcutaneous tissue. There is therefore a marked dif- 
ference between traumatic emphysema, where air pure and 
simple is contained in the tissues, and septic emphysema, 
where the tissues contain gases of putrefaction, as hydrogen, 
sulphuretted hydrogen, carbonic acid, etc. 

What are the symptoms of septic emphysema ? 

The presence of these putrefactive micro-organisms not 



CONGENITAL MALFORMATIONS 305 

only is followed by gas formation, but also by a train of 
symptoms suggestive of an inflammatory process of the skin 
and subcutaneous tissue. In other words, the characteristics 
of a septic cellulitis plus gas formation are present. 

How do you treat emphysema ? 

Compression and multiple punctures may be employed, 
but usually no treatment at all is necessary, provided, of 
course, the original cause of the emphysematous state is not 
a fractured rib, ruptured rectum, esophagus, etc. 

The treatment of septic emphysema must be an active 
one : deep and long incisions, with antiseptic treatment, and, 
if conditions warrant it, amputation of the septic member. 



CONGENITAL MALFORMATIONS. 

What congenital malforTnations are of practical surgical 
interest ? 

Genital Apparatus. 

MALES. 

What is a cryptorchid 9 

An animal the testicles of which are not in the scrotum. 
W hat is a monorchid ? 

An animal having only one testicle in the scrotum. 
Where are the undescended testicles ? 

Either in the abdomen or in the inguinal canal. 
What is phimosis 9 

Stenosis of the prepuce, rendering it difficult or impossible 
to uncover the glans penis. 



S06 PRINCIPLES OF VETERINARY SURGERY 

What is understood hy persistence of the urachus in colts and 
calves f 
At the time of birth the fundus of the bladder closes as 
the navel string tears. Should this physiological process be 
disturbed, the urine drips from the umbilical opening. 

What is the prognosis ? 

Favorable. 
What is the treatment ? 

Cauterization of the opening or closing it with a purse 
suture. 

FEMALES. 

Closure of the Vagina. — This condition, termed atresia 
vagince, when existing, is usually accompanied by an absence 
or imperfect development of the uterus. The hymen may be 
excessively developed and interfere with coitus. 

Digestive Apparatus. 

What is a hare-lip 9 

A gap in the continuity of the lip, being of foetal origin. 
What is a cleft palate ? 

A fissured state of the palate, being of foetal origin. 
Hoiu is a hare-lip and clef t palate formed ? 

The study of the development of the foetus teaches that 
by the coalescence of various clefts, fissures peculiar to foetal 
life are effaced. But when this union fails to take place, or 
becomes imperfect, certain deformities, as the hare-lip or 
cleft palate, remain. 

In what animals are the hare-lip and cleft palate seen 9 
Occasionally in the puppy and colt. 



CONGENITAL MALFORMATIONS 307 



Teeth. 



What congenital malformations of the jaws and teeth are of 
interest to the surgeon ? 

Quite common are supernumerary teeth, also tusks in 
canines and mares. By prognathia superior is understood an 
upper jaw which exceeds in length the lower jaw, commonly 
known as an overshot jaw; by hrachygnathia inferior is 
understood a lower jaw which is too short. The opposite 
condition — that is, an undershot jaw — simply reverses 
matters. 

Intestines. 

In what animals are congenital malformations of the intestine 
observed ? 
In pigs, colts, puppies, in the shape of a hernia ; another 
malformation, which is by no means rare, is partial or com- 
plete obliteration of the anus and rectum, known as atresia 
ani and atresia recti respectively. 

Eye. 

What are dermoid tumors ? 

Small, skin-like, hairy growths at the margin of the cor- 
nea, most frequently seen in dogs and calves, but occasionally 
also in other animals. 

What other congenital malformations are observed ? 

Paralysis of the optic nerve ending, known as amaurosis, 
cataracts; in horses, excessive development of the soot balls, 
congenital fissure of the iris, termed coloboma, closure of the 
inferior opening of the lachrymal canal ; in puppies, congen- 
ital closure of the palpabral fissure ; in dogs and colts, con- 
genital atrophy of the eye, known as microphthalmus. 



308 PRINCIPLES OF VETERINAEY SURGERY 

Mammary Gland. 

W hat congenital malformations of the udder are of practical 
surgical interest ? 
In cows, closure of the teat opening, congenital atrophy 
of one quarter of the udder. Occasionally the mammary 
gland is entirely wanting. In males, especially the he-goat, 
an excessive development of the mammary gland is sometimes 
observed. 

Skin. 

What congenital malformations of the shin interest the sur- 
geon ? 
Excessive growth of hair, known as hyperthrichosis, is 
seen upon the manes and tails of horses ; a congenital bald- 
ness {alopecia) in bovines, goats and horses. In dogs the 
claws are of interest ; they may be variously curved, termed 
onychogryphosis, or are imbedded in the skin on the style of 
the ingrown toe nail of man, which condition is called 
paronchia; or they develop to excess, which is termed hyper- 
onchia. 

Bony Skeleton. 

What congenital defects of the hony sJceleton interest the sur- 
geon 9 
In the pig especially, and occasionally in the horse, super- 
numerary phalanges are seen, a condition termed polydactyl- 
ism. In the pig, the coalescence of both claws into one is not 
uncommon and is called syndactylism. Sometimes one or 
more toes are wanting {perodactylism). 



CONGENITAL MALFORMATIONS 30^ 

Respiratory Apparatus. 

What congenital malformations of the respiratory apparatus 
are of practical interest ? 
In puppies, congenital struma is common. The tracliea 
may be twisted, excessively dilated or its lumen may be 
stenosed. In colts, nasal dyspnoea and catarrhal symptoms 
follow an abnormal development of the turbinated bones. 

Ear. 

What congenital malformations of the ear are of surgical 
interest 9 
In Maltese cats, congenital deafness is quite common. 



INDEX 



Abdominal hernia 50 

— wounds 2 

Abnormal granulations 17 

Abscess 69 

— acute 70 

— cold . 70 

— circumscribed 70 

— deep 71 

— diffused 70 

— formation of 69 

— gravitative 70 

— intermuscvilar 71 

— metastatic 70 

— superficial 71 

— symptoms of 71 

— subcutaneous 71 

— subperiosteal 181 

— treatment of 72 

— t3-mpanitic 70 

Acinous carcinoma 114 

Actinomyces fungus 121 

Actinomycomata 121 

Actinomycosis 21 

Actinomycosis of the mammary 

gland 123 

— of the muscles 124 

— of the skin 123 

— of tlie subcutis 128 

— of the tongue 124 

Actinomycotic mammitis 284 

— lymph glands 123 

Actual cautery as a hemostatic. . 11 
Acute arthritis 195 

— abscess 70 



PAGE 

Adenomata 117 

Alve6lar sarcoma 105 

Amj^elinic nerve fibres 1 GO 

Anchylosis 164, 213 

Angeioma 102 

Angiosarcoma 105 

Anemia 4 

Aneurism 264 

— aortic 265 

— cirsoid 264 

— false 264 

— sacciilated 264 

— treatment of 267 

— tubular 264 

Aneurismal varix 265 

Anthrax 21 , 30 

Antiseptic drugs 41 

Aortic aneurisms 265 

Aponeuroses, diseases of 251 

— necrosis of 251 

— rupture of 253 

Arrest of hemorrhage 7 

Arterial hemorrhage 2 

Arteries, diseases of 262 

Arteries, rupture of 268 

Arteritis 262 

Arthritis, acute 195 

— aseptic . 195 

— chronic 195 

— deforming 199 

— fibrinous 20 1 

— fiuigous 203 

— gouty 204 

— panneous 201 

— purulent 198 

— pyemic 203 



!12 



INDEX 



PAGE 

Arthritis, septic 105, 303 

— specific 196 

— traumatic 195 

Arthrogenous contracture 215 

Articular contracture 215 

— contusions 213 

— rheumatism 202 

Articulations, diseases of 195 

Aseptic arthritis '. . 195 

— wound fever 4 

Atheromatous cyst 120 

Atrophy, degenerative 249 

Atroj^hy of bone 189 

— of muscles 248 

B 

Bandages 41 

Benignant tumors 86 

Blackleg 30 

Blind fistula 77 

Blood, regeneration of 8 

Bone necrosis 189 

Bones, diseases of 151 

Bony wounds 2 

Botrj'omycoma 91. 125 

— of the mammary gland 127 

— of the muscles 127 

— of the spermatic cord 126 

Botryomycosis 21 

Botryomycotic mammitis 285 

Burns and scalds 293-29G 

Bursitis 236 

— purulent 237 

C 

Calculi, intestinal 133 

— lacteal ] 34 

— preputial 134 

— renal 1 32 

— salivary 134 

— ti'eatment of 135 

— urinary 133 

■Callus, ossification of 165 



PAGE 

Callus, permanent 163 

— provisional , . 163 

Cancer, encephaloid 108 

— scirrhous 108 

Cancerous cachexia 108 

Capillary hemorrhage 3 

Carcinoma of the mucous mem- 
brane 113 

— of the skin 113 

Caries 186 

— dental 187 

— necrotic 1 87 

Caro luxurians 17 

Cartilage wounds 20 

Cartilaginous tumor 98 

Cataplasms 64 

Catarrhal mammitis 282 

Causes of inflammation 56 

Cellulitis 21. 23- 

— circumscribed 25 

— diffused 26 

— gaseous 24 

— septic 26 

— specific 24 

— suppurative 23 

Cerebral paralysis 257 

Cervical wounds 2 

Changes of bandages 42 

Check of hemorrhage 10 

Chondroma 98 

Chronic arthritis 1 95 

— enduration 27 

Cicatricial contracture 216 

Cicatrization 14 

Circumscribed abscess 70 

— cellulitis 25 

Cirsoid aneurism 264 

Classification of wounds 1 

Cleft palate 306 

Clinical examination of tumors. 88 

Closure of the vagina 306 

Coagulation necrosis 18 

Coenurus cerebral is 140 

Cohnlieim's inclusion theorv .... 112 



INDEX 



313 



TAGE 

Cold abscess 70 

Cold and heat as hemostatics. ... 11 

Cold fomentations 63 

Collateral edema 301 

Coinminnted fracture 154 

Complete fistula 78 

Compound fibroma 91 

— fracture 154 

Concretions 133 

Condyloma 115 

Congelatio 296 

Congenital contracture 217 

— cyst 120 

— fistula 78 

— malformations 305-309 

Connective tissue tumors 87, 90 

Constituents of pus 22 

Constitutional effects of gangi-ene 84 

Continuous irrigation 63 

Contracture, arthrogenous 215 

— articular 215 

— cicatricial 216 

— congenital 217 

— myogenous 216 

— neurogenous 216 

— tendogenoiis 215 

Contused articulations 213 

— wounds 6 

Contusions 47, 212 

— causes of 47 

— definition of 47 

— degrees recognized 47 

— differential diagnosis 50 

— microscopical changes in 48 

— of practical interest 51 

— pi'ocess of resorption of 48 

of organization of 48 

of necrosis 49 

— symptoms of 49 

— termination of 48 

— treatment of 50 

Corneal wounds 2 

Corns 300 

Corpora libra 134, 217 



PAGE 

Cryptorchids 305 

Cysticercus celluloste 140 

Cystomata 120 

CJ^st, atheromatous 120 

— congenital 120 

— degeneration 119 

— dermoid , 120 

— extravasation 119 

— exvidation 119 

— retention. 120 

D 

Deforming arthritis 199 

Degeneration, reaction of , . 256 

Degeneration cyst 119 

Degenerative atrophy 249 

Dental caries 187 

— osteoma 99 

Depression fracture 153 

Dermatitis 286-292 

— eczematosa 289 

— erythematosa 289 

— gangrenosa 290 

— suppurative 287 

Dermoid cyst 120 

— tumors 307 

Description of wounds 4 

Diagnosis of cerebral paralysis . . 257 
Diffused abscess 70 

— cellulitis 26 

Diphtheritic inflammation 58 

Diseases of aponeuroses 251 

— of arteries 262 

— of articulations 195 

— of bones 151 

— of glands 276 

— of lymph vessels 273 

— of mucous membranes 300 

— of nerves 254 

— of the skin 286 

— of the subcutis 301 

— of veins 270 

Dislocations 206 

Dissecting aneurism 265 



314 



INDEX 



PAGE 

Distortion 209 

Disturbed function 3 

Drainage 43 

Dressings 41 

Dropsy of tendon sheaths 232 

Dropsy of the mucous bursa 238 

DrvTgs, antiseptic 41 

Dry gangrene 81 

E 

Eczema 289 

Edema 301 

Electrical properties of inuscles 

and nerves 256 

Elephantiasis 94, 288 

Emphy sema 303 

— septic 304 

Emi^hysematous gangrene 81 

Empyema 58 

Enceplialoid cancer 108 

Endocarditis 202 

Endotlielioma 105 

Enduration, chronic 27 

Epiblastic tumors 108 

Epithelial neoformations 108 

— tumors 87 

Erethistic granulations 18 

Erythema 286 

Etiology of lipomata 96 

— of tumors 87 

Excretory fistula 80 

Exfoliation 189 

Exostosis 99, 190 

Extravasation cyst 119 

Exuberant granulations 18 

Exudation cyst 119 

F 

Facial paralysis 259 

False aneurism 264 

— neuroma 100 

Fatty tumor 95 

Fever, septic 4 

— traumatic 4, 21 



PAGE 

Fibrinous arthritis 201 

— inflammation 57 

Fibroma 90 

— comjiound 91 

— durum 90 

— hard 90 

— molle 90 

— seats of predi'ection of 92 

— soft 90 

Fibrous calkis 164 

— tumor 90 

Filaria papillosa 140 

Fissure fracture 153 

Fistula 77 

— action and results of in the 

skin and underlying parts . 138 

— blind 77 

— classes recognized 77 

— congenital 78 

— description of 77 

— operations for 80 

— l^urulent 78 

— secretory 80 

— symptoms of 78 

— treatment of 79 

— A-arieties of 77 

Foreign bodies 135 

— definition of 135 

— effect upon cattle 137 

— in the eye and ear 138 

— in the mouth 135 

— in the pharynx and esophagus 136 

— in the stomach of cattle 136 

— in the stomach and intestines 

of dogs 137 

— in the rectum and m-ethra. . . . 137 

— in the respiratory apparatus. . 137 

— of surgical interest 135, 140 

— treatment for 139 

Founder 300 

Fractures 151 

— animals most subject to 155 

— caiises of 151 

— classification of 152 



INDEX 



315 



PAGE 

Fractui-es. comminuted 154 

— compound 154 

— definition of 151 

— dentated 154 

— diagnosis of 154 

— healing of 163. 166. 179 

— in the dog 176 

— in the horse 173 

— longitudinal 154 

— niultii^le 154 

— oblique 154 

— prognosis of 159 

— reduction of 167 

— transverse 154 

— treatment of 166, 168, 172 

— T-shaped 154 

— V-shaped 154 

Frost-bite 396 

Fungous arthritis 202 

— ulcer 75, 77 

Furuncles 288 

G 

Galls 232 

Gangrene 81 

— causes of 82 

— classification of 81 

— constitutional effects of 84 

— definition of 81 

— dry 81 

— emphysematous 81 

— ichorous 81 

— moist 81 

— phagedenic 81 

— putrid 81 

— treatment of 85 

Gangrenous inflammation 58 

— mammitis 283 

Gaping of wounds 3 

Gaseous cellulitis 24 

General surgery 1 

Giant-celled sarcoma 105 

Glanders 21, 38 



PAGE 

Glands, diseases of 276 

Glandular tumors 117 

Granulations, abnormal 17 

— erethistic 18 

— exuberant 18 

Gravitative abscess 70 

Green stick fracture 153 

Gouty arthritis 204 

Gunshot wounds 6 



H 



Hard fibroma 90 

Hare-lip 306 

Healing of fractures 163. 166 

— of non-vascvilar tissues 20 

— of wounds 13-17 

Hematoma 50 

Hemiplegia 254 

Hemophilia 12 

Hemorrhage 2 

— arrest of 7, 10 

— arterial 2 

— capillary 3 

— check of 10 

— constitutional treatment of . . 12 

— parenchymatous 3 

— regeneration of blood after. . . 8 

Hemorrhagic inflammation 58 

Hernia 141 

— abdominal 50 

— definition of 141 

— incarcerated 143 

— inguinal 147 

— make-up of a 141 

— muscular 141 

— of the brain 141 

— pelvic 146 

— reducible 142 

— strangulated 143 

— treatment of 144 

— umbilical 146 

— varieties of 141, 146 

— ventral 146 



316 



INDEX 



PAGE 

Hygroma '2'SS 

Hyperostosis 190 

HyperlropJiy of bone 190 

Hypoblastic tumors 108 

I 

Ichorous gangrene 81 

— pus 22 

Immersion 63 

Impaction displacement 155 

Impaired function 60 

Incarcerated hernia 143 

Incised wounds 5 

Incomplete fracture 153 

Infection, parasitic 112 

Infectious arthritis 195 

— cellulitis 23 

— diseases, traumatic 21, 34 

— neoformations 121 

Inflammation 55 

— abscess 58 

— causes of 56 

— diphtheritic 58 

— fibrinous 57 

— gangrenous 58 

— hemorrhagic 58 

— of bone 178 

— of mammary gland 279 

— of osseous tissue 182 

— of veins 270 

— lihlegraonous 23 

— productive 59 

— purulent 58 

— serous 57 

— specific 59 

— ti-eatment of 62 

Inflammatory edema 301 

Inguinal hernia 146 

Instruments 41 

Interstitial lymphadenitis 278 

— mammitis 283 

— myositis 244 

Intestinal calculi 133 



PAGE 

Intestinal wounds 2 

Intoxication, septic 30 

Invagination 148 

Inversion 148 

K 

Keloids 18, 91 

Keraphyllocele 300 

Kryptogenetic septicemia 30 

Lacerated wounds 5 

Lacteal calculi 134 

Laminitis 30O 

Leontiasis ossea 191 

Ligation of blood vessels 10 

Ligatm-es 41 

Lipoma 95 

Lipomata, etiologj^ of 96 

Lipomatous atrophy 250 

Liquor pmis 22 

Loose bodies in the joint 217 

Luxation of a joint 205 

Lymphadenitis 276 

— parenchymatous 277 

— purulent 278 

— specific 277 

Lyraphangiectasis 276 

Lymphangitis 273 

— specific 274 

Lymi^hatic gland tumor 103 

Lympho-sarcoma 105 

Lymph vessels, diseases of 27S 

M 

Malformations, congenital 305 

Malignant lymphoma 103 

Malignant ojdema 21, 30, 34 

— definition of 34 

— post-mortem changes of 35 

— symptoms of 35 

— termination of 35 

— treatment of 35 



INDEX 



317 



PAGE 

Malignant tumors i^6 

Mammitis 279-285 

— botiyoniycotic 285 

— gangrenous ... 283 

Massage 66 

Mastitis 279 

Melanotic sarcoma 105, 107 

Metastatic abscess 71 

— cellulitis 24 

Mixed celled sarcoma 105 

Moist gangrene 81, 84 

Monarthritis 196 

Monday morning disease 27 

^Monoplegia 25 1 

Monorchids 305 

Mortality in tetanus 38 

Mucous membranes, diseases of . . 800 

Mucous tissue 96 

Mucous tumor. . . 96 

Multiple fracture 154 

Muscles, rupture of 52, 246 

— atrophy of 248 

Muscular atrophy 248. 250 

— rheumatism 245 

— tumor 99 

— wounds .2. 19 

Mycofibroma 91 

Myelinic nei've fibres 100 

Myogenous contracture 216 

Myoma 99 

Myositis 239 

— ossifying 244 

— purulent 242 

— rheumatic 245 

Myxoma 96 

N 

Necrosis 27, 49. 186 

— of aponeuroses 251 

Necrotic caries 187 

— paralysis 258 

— tumors 1 00 

Neof ormations, epithelial 1 08 

Nerves, diseases of 254 



PAGE 

Neuritis 260 

Neurofibromata 101 

Neurogenous contracture 216 

Neuroma, false 100 

Netuomata 100 

O 

Odontoma 99 

(Edema bacillus 34 

Open wounds 1 

Opisthotonos 37 

Orthotonos 37 

Osseous tumor 99 

Ossification of callus 165 

Ossifying myositis 244 

Osteitis 178 

— causes of 182 

— course of 182 

— deforming 184 

— fungous 184 

— ossifying 183 

— rarefying 183 

Osteoclasts 164 

Osteoma, dental 99 

Osteomalacia 193 

— causes of 192 

— definition of 192 

— symptoms of 193 

— treatment of 193 

Osteomyelitis 178 

Osteophytes 190 

Osteoporosis 183, 193 

Osteosclerosis 190 

Over-riding dis}>lacement 155 

P 

Panneous arthritis 201 

Papilloma 115 

Paralysis 254 

— facial 259 

— nerve 258 

— peripheral 258 

— radial 259 

— spinal 258 



118 



INDEX 



PAGE 

Parasitic infection 113 

Parenchymatous hemorrhage. ... 3 

— lymphadenitis 277 

Paresis 234 

Pelvic hernia 146 

Pentastomum taenoides 140 

Periarthritis 196. 205 

Periarticular ringbone 205 

Perilymphadenitis 277 

Periostitis 179 

— acute aseptic 179 

— acute purulent 181 

— chronic fibrous 182 

— chronic purulent 181 

Peripheral paralysis 258 

Permanent callus 168 

Persistence of the virachus 306 

Phagedenic gangrene 81 

— ulcer 77 

Phimosis ... 305 

Phlebitis 270 

Phlegmonous inflammation 23 

Phlogosia 57 

Pleui-osthotonos 37 

Pododermatitis 299 

Poisoned wounds 7 

Polyarthritis 196 

Polypus 91 

Preputial calculi 134 

Priessnitz fomentations 65 

Prola])sus . 147 

— of the bulb of the eye 150 

— of the intestines 149 

— of the omentum 149 

— of the penis 150 

— of the rectum 149 

— of the tongue 150 

— of tlie uterus 150 

— of tlie vagina 150 

Prophylaxy of tetanus 37 

Provisional callus 163 

Pseud oartlu-osis 164 

Punctured wounds 5 

Purulent artluitis 198 



PAGE 

Purulent bursitis 237 

— fistula 78 

— infiltration 58 

— inflammation 58 

— lymphadenitis 278 

— myositis. 242 

— tendovaginitis 232 

Pus, constituents of 22 

— ichorous 22 

— sanious 22 

Putrid gangrene 81 

Pyemia 21 , 32 

Pyemic arthritis 203 

R 

Rabies 38 

Rachitis, causes of 191 

— characteristics of 191 

— symptoms of 192 

— treatment of 192 

Radial paralysis 259 

Reaction of degeneration 256 

Reduction of fractures 167 

Regeneration of blood 8 

Regeneration of tissue 19 

Renal calculi 132 

Retention cyst 120 

Retraction of tibial aponeurosis. . 253 

Rheumatic myositis 245 

Rheumatism, articular 202 

Rice kernel bodies 134 

Rickets 191 

Ringbone, periarticular 205 

Rotary displacement 155 

Round-celled sarcoma 105 

Rubor 59 

Rupture of aponeuroses 253 

— of arteries 268 

— of muscles 52, 246 

— of tendons 53, 225 

S 
Sacculated anevu-ism 264 



INDEX 



319 



PAGE 

Saliva 3 

Salivary calculi 134 

Sanious pus 22 

Saphrophytes 112 

Sapremia 30 

Sarcoma 104 

Sarcoma, alveolar 105 

— giant-celled 105 

— round-celled 105 

— spindle-celled 105 

Scirrhous cancer 108 

Seats of predilection of fibroma.. 92 

Secretoi y fistula 80 

Septic arthritis 195. 203 

— cellulitis 26 

— emphysema 304 

— fever 4 

— intoxication 30 

Septicaemia liemorrhagica 30 

Sei)ticemia 21, 29 

Septico pyemia 33 

Sequestration, process of 188 

Sequestrum 188 

Serous arthritis 196 

— inflammation 57 

Shoeboil 51 

Simple fracture 152, 166 

Skin, diseases of 286 

— grafting 46 

— wounds 2 

Soft fibroma 90 

Softening of the thrombus 10 

Specific arthritis 196 

— cellulitis 24 

— lymphadenitis 277 

— lymphangitis 274 

Spinal paralysis 258 

Spindle-celled sarcoma 105 

Sprain 209 

Stasis edema 302 

Strain fractui"e 153 

Strangulated hernia 143 

Subcutaneous abscess 71 

— ruptures 52 



PAGE 

Subcutaneous wounds 1 

Subcutis, diseases of 301 

Subluxation 205 

Subperiosteal abscess 181 

Suppuration of wounds 31 

Suppurative cellulitis 23 

— dermatitis 287 

Symptomatique anthrax 38 

Synosteosis 164 

Synovia 3 

T 

Tendinitis 219-225 

Tendogenous contracture 215 

Tendon necrosis 228 

— wounds 19 

Tendons, rupture of 53, 225 

Tendovaginitis 230 

— purulent 233 

Tetanus 35 

— animals subject to 36 

— forms of 37 

— inoculation experiments for. . 36 

— prophjdaxy of 37 

— symptoms of 36 

— termination of 37 

— treatment of 38 

Thoracic wounds .... 3 

Thrombophlebitis 270 

Thrombus 8 

Tibial aponeuroses, retraction of. 253 

Tissue, regeneration of 19 

Torsion as a hemostatic 11 

Transverse displacement 155 

Traumatic arthritis 195 

— fever 4,21, 28 

— infectious diseases 21, 34 

— luxations 206 

Treatment of abscess 72 

— aneurisms 267 

— calculi 135 

— contusions 50 

— fistula 79 



320 



INDEX 



PAGE 

Treatment of foreign bodies 139 

— fractures 166, 168, 172 

— gangrene 85 

— gunshot wounds 45 

— hemorrhage 12 

— hernia 144 

— inflammation 62 

— malignant oedema 35 

— rachitis 192 

— specific woiinds 43 

— tetanus 38 

— tuberculosis 132 

— ulcers 75 

— wounds 39 

True aneurism 264 

— neuroma 100 

Tubercular mammitis 284 

Tuberculosis 31, 128 

— definition of 128 

— forms of surgical interest .... 128 

— of bones and joints 130 

— of muscles 131 

— of the brain and spinal cord . . 131 

— of the eye 131 

— of the lymph glands 129 

— of the mammary glands 129 

— of the mucous membranes. . . . 130 

— of the skin and subcutis 129 

— of the testicles 131 

— treatment of 132 

Tubular adenoma 117 

— aneurism 264 

Tumors 86 

— definition of 86 

— cartilaginous (chondroma) ... 98 

— classification of 86 

— epiblastic and hypoblastic. . . . 108 

— epithelial 87. 108 

— etiology of 87 

— clinical examination of 88 

— connective tissue 87, 90 

— fatty (lipoma) 95 

— glandular 117 

• — lymphatic gland (lymplioma) 108 



PAGE 

Tumors, mucous 96 

— muscular (myoma) 99 

— nerve (neuroma) 100 

— osseous (osteoma) 99 

— vascular (angeioma) 103 

— warty or villous 115 

Tyloma 94 

Tylosis 94 

Tympanitic abscess 70 

U 

Ulcers 73-77 

— causes of 73 

— circumstances encouraging . . 74 

— classes recognized 73 

— definition of 73 

— description of 75 

— forms known 74 

— fungous 77 

— healthy 76 

— indolent 76 

— phagedenic 77 

— treatment of 75-77 

Umbilical hernia 146 

Urachus, persistence of the 306 

Urinary calculi 133 

V 

Varicose veins 272 

Varieties of infiammation 57 

Varix 373 

Vascular tumor 103 

Vasomotor paresis 4 

Veins, diseases of 370 

Ventral hernia 146 

Verrvica 115 

Villous tumors 115 

w 

Warty tumors 115 

Wild plague 38 

Wound diphtheria 38 

Wound fever, aseptic 4 



INDEX 



321 



PAGE 

Wounds 1 

— bony 2 

— classification of 1 

— contused 6 

— definition of 1 

— description of 4 

— fever in 4 

— gaping of 3 

— gunshot 6 

— healing of 13, 17, 19 



PAGE 

Wounds, hemorrhages in 3 

— incised 5 

— influence on health of 3 

— lacerated 5 

— open 1 

— pain in 2 

— poisoned 6 

— piuactured 5 

— subcutaneous 2 

— symptoms of 1 



JUL 8 190.^ 



LIBRARY OF CONGRESS 



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